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

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

• Holmium laser enucleation of the prostate
• Metabolic acidosis
• Bladder irrigation
• Normal saline