High ammonia levels may result in neurologic disturbance. It is not metabolized and excreted purely by the kidneys. Absorption of larger amounts of mannitol will shift fluids into the vascular compartment and lead to quick fluid overload, pulmonary edema, and cardiac failure. Sorbitol is an non-toxic isomer of mannitol. Absorption of large amounts of sorbitol may lead in addition of the complications of fluid overload to hyperglycemia and hypercarbia.
Cytal solution is a combination of mannitol and sorbitol.
All other vital signs remained stable. Another clue to a hypervolemic state might be hypertension and reflex bradycardia. The patient was still intubated and sedated. Therefore, we were unable to assess his neurological function, but we can assume that secondary to his profound hyponatremia, hypoosmolality and high ammonia levels he would have had some neurological abnormality. Early recognition and early treatment of a TURP syndrome is an extremely important factor in its therapy.