Electrolyte (Na-K) and hematologic (Hb-Hct) changes during percutaneous nephrolithotomy (PCNL) with distilled water and normal saline

One of the important complications of percutaneous nephrolithotomy (PCNL) is rapid absorption of irrigation fluid via opened veins that may cause serum hematologic and electrolyte changes. The aim of this study was to evaluate the effect of distilled water and normal saline as an irrigation fluid for PCNL on the serum concentration of sodium, potassium, hemoglobin and hematocrit. Sixty patients with kidney calculi were candidated for elective PCNL and randomly divided into two groups for PCNL. Approaches to the calculi were through a single subcostal access with an Amplatz sheath and either distilled water or normal saline. Solution was used as the irrigation fluid. Serum hemoglobin, hematocrit, sodium and potassium were measured just before and after the procedure. The mean calculus size, irrigation volume, irrigation time, age, gender and ASA were not significantly different between the two groups. In two groups, compared to before PCNL, the mean in hemoglobin and hematocrit were significantly reduced after PCNL (p<0.001), but did not change the sodium and potassium of the procedure. The mean change of sodium, potassium, hemoglobin and hematocrit did not difference in before and after PCNL for two groups (p>0.05). None of the patients developed transurethral resection of the prostate syndrome or needed transfusion. Distilled water is an inexpensive and available alternative to normal saline for irrigation during PCNL. Compared to before PCNL, hemoglobin and hematocrit were significantly reduced after PCNL, but did not change the sodium and potassium. We did not find any difference between the two irrigation solutions regarding the safety, however, this should be confirmed further, especially for large calculi. We recommend, evaluation of serum hemoglobin and hematocrit levels on the postoperative day as mandatory.