NEUROTOXIC ROLE OF GLYCINE AND ITS DERIVA TES DURING TRANSURETHRAL PROSTATE RESECTION

72-year-old patient underwent an elective transurethral resection of t he prostate (TURP) performed with a spinal anaesthesia. The irrigation solution contained glycine at a concentration of 15 g . l-1. The pati ent's level of consciousness deteriorated over the next 4 hours. He we nt in an areflexic coma with pupillar areflexia and left mydriasis. Th e diagnosis of TUR syndrome was substantiated by a sodium blood concen tration of 98 mmol . l-1, an osmotic gap of 48 mosmol . kg-1 and blood ammonia at 415 mumol . l-1. To investigate the pathophysiological rol e of glycine and its metabolites, their concentrations were measured b y chromatography and spectrometry in plasma and CSF 8, 24 and 48 hours postoperatively. Glycine and its metabolites (serine, alanine, glyoxi lic acid and glycolic acid) accumulated during the postoperative perio d in both blood and CSF. The central nervous system is in direct conta ct with these neurotropic compounds. Glycine is an inhibitory neurotra nsmitter, whereas glyoxilic acid and glycolic acid are considered as t o be neurotoxic.