Simulated intraperitoneal absorption of irrigating fluid

Abstract

Background: Intraperitoneal absorption of electrolyte-free irrigating fluid may occur secondary to uterine perforation during endometrial resection, but the clinical course of this complication is known from only a few case reports.

Methods: We studied symptoms, biochemical changes and the kinetics of solute equilibration over the peritoneal membrane in 10 healthy awake women who were subjected to an experimental absorption situation by receiving an intraperitoneal infusion of 25 ml/kg of a solution containing glycine 1.5% and ethanol 1% over 20 min. We also compared the use of breath ethanol and serum sodium samples to indicate the presence of irrigating fluid in the peritoneal cavity.

Results: All infusions caused lower abdominal pain. The solute gradients between the peritoneal pool and plasma were reduced according to mono-exponential functions with a half-time of 33 +/- 5 min for ethanol, 92 +/- 9 min for sodium, 103 +/- 9 min for potassium, and 124 +/- 10 min for amino acids (mean +/- s.e.mean). Twenty minutes after infusion, the breath ethanol level reached a plateau which could be used to predict the infused volume within +/- 15% of the true value. In contrast, the serum sodium concentration decreased slowly and was only 3.0 +/- 0.7 mmol/l below baseline at 2 hours after infusion.

Conclusions: The calculated rates of transperitoneal solute equilibration can be used to assess the need for substitution of electrolytes in patients who absorb irrigating fluid into the peritoneal cavity. Measurement of ethanol in the expired breath is more useful than serum sodium to indicate the existence of such a pool.