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To the Editor: In the TURP syndrome, changes in serum potassium have not been evaluated precisely. Jensen I described the causes of potassium change during the TURP syndrome, but others should be added. If the serum potassium concentration does not change during the TURP syndrome it suggests that intracellular potassium is extruded to the extracellular space, to compensate for renal potassium losses and keep serum potassium constant. Non-electrolyte hypotonic solutions, glycine, sorbitol or mannitol, are usually used as a perfusate for TURP, and the large leakage into the blood vessels makes the extracellular fluid hypotonic. Hypotonic stress in extracellular space induces cell swelling, but the swollen cells tend to return to their original volume within a few minutes. 2'3 This physiological cell volume "regulatory volume decrease (RVD)," involves effiux of potassium and water from the intracellular space. 4"5 Potassium extrusions from the cells by RVD have been reported in erythrocytes, lymphocytes, hepatocytes, and renal cells. 24 Physiologically, these cells may be exposed to hypotonic stress by water drinking but they should keep their cell volume constant. In the TURP syndrome, these cells may also show an RVD response and extrude potassium into the extracellular space. The RVD response should be considered in evaluating changes in serum potassium concentration during TURP syndrome.

Serum potassium change during the TURP syndrome by cell volume regulation