A rare case of hyperchloraemic normal anion gap metabolic acidosis due to absorption of normal saline irrigation fluid during holmium laser enucleation of prostate

Justina Cheh Juan Tai; Muhammad Pervaiz; Shameer Deen; Ali Tasleem; Nkwam Nkwam

doi:10.1016/j.eucr.2023.102470

A rare case of hyperchloraemic normal anion gap metabolic acidosis due to absorption of normal saline irrigation fluid during holmium laser enucleation of prostate

Urol Case Rep. 2023 Jun 21:50:102470. doi: 10.1016/j.eucr.2023.102470. eCollection 2023 Sep.

Authors

Justina Cheh Juan Tai¹, Muhammad Pervaiz¹, Shameer Deen¹, Ali Tasleem¹, Nkwam Nkwam¹

Affiliation

¹ Princess Royal University Hospital, King's College Hospitals NHS Foundation Trust, London, UK.

Abstract

Holmium laser enucleation of the prostate (HoLEP) is the preferred technique for surgical management of benign prostatic hyperplasia in prostates over 80 cc in size. A 72-year-old male underwent a HoLEP for catheter-dependent urinary retention in the context of a 204 cc prostate. At the end of the procedure he was clinically overloaded and had developed a combined respiratory and hyperchloremic normal anion gap metabolic acidosis secondary to excessive absorption of normal saline irrigation fluid. He was transferred to the ICU for diuresis and supportive care where he made a full recovery.

Keywords: Bladder irrigation; Holmium laser enucleation of the prostate; Metabolic acidosis; Normal saline.

Publication types

Case Reports