# Acute Respiratory Failure and Metabolic Acidosis Due to Excessive Normal Saline Absorption During Hysteroscopic Myomectomy: A Case Report

## TL;DR

A patient developed severe acidosis and respiratory failure from too much normal saline during a hysteroscopic myomectomy, highlighting the need for careful fluid monitoring.

## Contribution

This case report highlights the rare but serious complication of excessive normal saline absorption during hysteroscopic myomectomy.

## Key findings

- Excessive normal saline absorption caused acute respiratory failure and severe hyperchloremic metabolic acidosis.
- The patient recovered after mechanical ventilation and intensive care.
- The case emphasizes the importance of monitoring fluid balance during hysteroscopic procedures.

## Abstract

Hysteroscopic myomectomy commonly employs fluid irrigation to maintain visualization of the uterine cavity, with normal saline often used as the distension medium due to its favorable safety profile. However, significant intravascular absorption of isotonic fluids can result in life-threatening complications. We report a case of acute respiratory failure and severe hyperchloremic metabolic acidosis caused by excessive absorption of normal saline during hysteroscopic myomectomy. The patient required mechanical ventilation and intensive care but recovered fully with timely and appropriate management. This case underscores the need for vigilant fluid balance monitoring during hysteroscopic procedures, even when isotonic irrigation solutions are used.