4 thoughts on “Episode 196: Keywords part 16: Urologic surgery and Renal Failure”

1. Question about hypertonic saline vs loop diuretic for TURP/ hyponatremia. My understanding is that slow infusion of 3% hypertonic saline (100ml/h or less) would be the initial treatment for Na<120, before a loop diuretic. In the example in the podcast when a patient has a sodium of 116 with moderate symptoms, the recommended initial treatment is a loop diuretic. Is it possible to get additional clarification/ explanation for this please? Thank you!

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   1. This may vary from place to place but some say to only use hypertonic saline in emergency situations such as a seizing patient. Otherwise slow correction is safer.

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2. Hello Dr. Wolpaw,

   Really love the show, I am a French Canadian listener and also an anesthesiology resident.

   My comment is for the question of renal failure and enflurane anesthetic (36 min).

   I think this question may be about fluoride-induced nephrotoxicity. This subject is not explained great details in Barash (8th ed. p. 482) or Miller’s (9th ed. p. 530). This toxicity was associated with methoxyflurane and enflurane metabolism.
   Methoxyflurane undergoes extensive metabolism and release of inorganic fluoride ions (F−).
   Enflurane and methoxyflurane have an intrarenal metabolism responsible for a higher local inorganic fluoride concentration (probably more than plasma concentration).
   Of course this was more relevant in longer exposition to those inhaled anesthetics. From my understanding the clinical presentation is polyuric renal insufficiency.

   This concept is probably going away with the more modern inhaled anesthetics (less soluble, less biotransformation)

   Thank you, very much!

   Simon Robichaud

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   1. Fantastic Simon, thanks for sharing that knowledge!

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