Which action should be taken when nasal drainage is suspected after transsphenoidal hypophysectomy?

Which action should be taken when nasal drainage is suspected after transsphenoidal hypophysectomy?

• A. Test the drainage for glucose
• B. Lower the head of the bed
• C. Obtain a culture of the drainage
• D. Continue to observe the drainage

Answer: (A)

The key idea is identifying a CSF leak after transsphenoidal hypophysectomy. CSF contains glucose, while nasal mucus does not, so testing the suspected drainage for glucose serves as a quick, practical way to confirm whether CSF is leaking. A positive glucose result indicates a CSF leak, which is a urgent finding that prompts prompt management to protect the central nervous system—quiet bed rest with the head of bed elevated, avoidance of straining or coughing, and rapid involvement of the surgical team for potential repair and infection prevention. The other actions don’t diagnose a leak as reliably or promptly: lowering the head of the bed isn’t diagnostic and could worsen the leak, culturing the drainage addresses infection but doesn’t establish whether CSF is present, and simply observing may miss a leak and increase meningitis risk.

The key idea is identifying a CSF leak after transsphenoidal hypophysectomy. CSF contains glucose, while nasal mucus does not, so testing the suspected drainage for glucose serves as a quick, practical way to confirm whether CSF is leaking. A positive glucose result indicates a CSF leak, which is a urgent finding that prompts prompt management to protect the central nervous system—quiet bed rest with the head of bed elevated, avoidance of straining or coughing, and rapid involvement of the surgical team for potential repair and infection prevention. The other actions don’t diagnose a leak as reliably or promptly: lowering the head of the bed isn’t diagnostic and could worsen the leak, culturing the drainage addresses infection but doesn’t establish whether CSF is present, and simply observing may miss a leak and increase meningitis risk.