This is part two of a two-part case; see the previous case for related information.
After you make the diagnosis, you start the patient on various medications but he is still symptomatic. You then refer to urology who decides to do a surgical intervention. He is scheduled for a standard transurethral resection of the prostate. In the PACU, the patient is noted to be confused, disoriented, twitching, and hypotensive. Standard labs are sent and the sodium comes back 95 mEq/L. The osmolal gap is 40 mosm/kg.
The image above shows the tiny bits of removed prostate.
Challenge: What happened?
Image shown under fair use.