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Hypotension and mixed metabolic and respiratory acidosis: case report A 48-year-old woman developed mixed metabolic and respiratory acidosis during treatment with sodium chloride and subsequently, she also developed transient hypotension following administration of nitroglycerine. The woman developed acute respiratory distress while undergoing hysteroscopy for submucosal myomectomy. During surgery, she was administered 19100mL of sodium chloride [saline] for intra-uterine irrigation and subsequently, she developed acute dyspnoea and facial oedema. Arterial blood gas analysis indicated mixed metabolic and respiratory acidosis with PaCo2 of 57.8mm Hg, pH 6.989 and bicarbonate concentration of 14 mmol/L. Progressively, she developed desaturation and PaO2/FiO2 ratio was 121.5mm Hg and SpO2 was 85%. On arrival to the ICU, ultrasonography showed pulmonary oedema considered secondary to transurethral resection syndrome. Thus, she was treated with furosemide, but no significant improvement was noted. Thereafter, further treatment was started with high dose IV nitroglycerine 1mg. After 5 minutes, she was given another bolus dose of nitroglycerine 1mg followed by continuous infusion of nitroglycerine at the rate of 1 mg/hr. However, she developed transient hypotension. After treatment with nitroglycerine, improvement was noted in the arterial blood gas analysis. Laboratory tests showed pH of 7.304, PaO2 was 64.4mm Hg, PaCO2 was 46.9mm Hg and lactate level improved to 38 mg/dL. The next day, chest X-ray indicated resolution of bilateral pulmonary congestion. After 3 days of surgery, she was discharged home. Huang SH, et al. Gynaecological transurethral resection of the prostate syndrome-induced acute pulmonary oedema treated with high-dose nitro-glycerine: A case report. Hong 803501259 Kong Medical Journal 26: 339-341, No. 4, Aug 2020. Available from: URL: http://doi.org/10.12809/hkmj198139

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