• PDF / 171,477 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 96 Downloads / 196 Views

DOWNLOAD

REPORT

---

1

S

Metabolic acidosis and acute pulmonary oedema: case report A 44-year-old woman developed metabolic acidosis following administration of midazolam, propofol, sevoflurane, sufentanil and developed acute pulmonary oedema following administration of sodium-bicarbonate [routes not stated]. The woman, who had cervical intraepithelial neoplasia grade III, was admitted to hospital. She was scheduled for a total laparoscopic hysterectomy and curettage. No history of drug allergies, alcoholism or diseases was noted. Laboratory and physical examinations were found to be within normal limits. She did not receive any solid food for 3 days before her surgery. In operation room, she received propofol 120mg, sufentanil 20µg and midazolam 2mg along with cisatracurium for the induction of anaesthesia. She was intubated and received 3% sevoflurane for maintaining the anaesthesia. During the operation, she exhibited hypotension. Following treatment with fluid therapy, BP increased. After three hours of surgery completion, she received crystalloid and colloid solution. Subsequently, her spontaneous breathing recovered. However, she was unconscious and unresponsive to external stimuli. Immediately, a radial artery blood gas analysis was performed and her blood glucose level was found to be 3.7mmol/dL. Based on the blood gas analysis, she was diagnosed with metabolic acidosis and hypoglycaemia [durations of treatments to onset of reaction not stated]. The woman therefore immediately received 5% sodium bicarbonate 125mL infusion and glucose solution. After 10 minutes, the tidal volume and PETCO2 were found to be 887mL and 28mm Hg respectively. The blood gas analysis showed decrease in BE. Approximately 10 minutes later, she opened her eyes with no stimulation and started swallowing. Afterwards, the tracheal tube was removed. Following her transfer to ICU for further treatment, her SPO2 declined to 83% to 85%. Lung auscultation revealed crackles in both lungs. Subsequently, acute pulmonary oedema developed. It was considered to be related to the excessive volume load that was caused by the rapid administration of sodium bicarbonate. The woman then received furosemide to promote diuresis and liquid infusion was limited. At this time, her urine level was found to be 1000mL. After eight hours of operation, the blood gas analysis showed that the metabolic acidosis and pulmonary oedema had completely resolved. On the second day of operation, she developed nausea and vomiting of an unknown aetiology and she was transferred to the department of gastroenterology. Author comment: "[R]apid infusion of 5% sodium bicarbonate may result in volume overload and may cause a risk of acute pulmonary edema." "Prolonged fasting during the preoperative period. . .the effects of anesthesia and surgery will increase the levels of glucocorticoids. All of these factors will then accelerate lipid metabolism, which may cause starvation ketoacidosis." Zhou W, et al. Preoperative prolonged fasting causes severe metabolic acidosis: A case report. Medicine 98: No.