CHANGES IN AMINO-ACIDS, AMMONIUM, AND COAGULATION-FACTORS AFTER TRANSCERVICAL RESECTION OF THE ENDOMETRIUM WITH A GLYCINE SOLUTION USED FORUTERINE IRRIGATION

OBJECTIVE: Transcervical resection of the endometrium with the use of 1.5% glycine for irrigation is associated with postoperative nausea in some patients. This could be because of hyponatremia or toxic effects of glycine and its metabolites, Moreover, 1.5% glycine is hypoosmolar , and hemolysis and fibrinolysis are possible. Changes in plasma facto rs related to these potential complications of transcervical resection of the endometrium were measured. STUDY DESIGN: In 101 patients under going transcervical resection of the endometrium sodium, ammonium, and coagulation factors were measured preoperatively and postoperatively at intervals. In the initial 30 patients glycine and 28 other amino ac ids were measured at the same intervals. The results were correlated w ith the patients' clinical status and operative parameters, RESULTS: G lycine and nine other amino acids and ammonia showed increased postope rative plasma levels; these changes were correlated with the absorptio n of the irrigating glycine solution and the development of hyponatrem ia. Minor activation of fibrinolysis and hemolysis was also seen. CONC LUSION: Nausea after transcervical resection of the endometrium with 1 .5% glycine for irrigation may be partly explained by toxic effects of glycine and its secondary metabolites in addition to the effects of w ater intoxication and hyponatremia. Minor, clinically insignificant ch anges in the coagulation system may also occur. Studies on alternative s to glycine for creation of near-isotonic irrigating solutions are en couraged.