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Case Report
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| Iatrogenic saline toxicity complicated by malnutrition | ||||||
| Muhammad Uneib1, Parin Rimtepathip2, Harold P. Katner3 | ||||||
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1MS III, Ross University School of Medicine.
2MS III, Mercer University School of Medicine. 3MD, Department of Infectious Disease, MUSM. | ||||||
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| How to cite this article |
| Uneib M, Rimtepathip P, Katner HP. Iatrogenic saline toxicity complicated by malnutrition. Int J Case Rep Images 2015;6(4):216–219. |
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Abstract
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Introduction:
Hypotension is a common presenting symptom in elderly patients with malnutrition and dehydration, often being treated with a continuous volume of 0.9% normal saline. Since normal saline is slightly hypertonic, prolong continuous treatment with normal saline can result in hyperchloremic non-anion gap metabolic acidosis. Patients with a low albumin state are also at risk for third spacing that can lead to generalized edema.
Case Report: We present a 63-year-old Caucasian female with history of schizophrenia, traumatic brain encephalopathy, and chronic kidney disease stage III who presented to the emergency room from a nursing home due to altered mental status and low blood pressure. The patient received continuous infusion of normal saline despite failure of improvement in blood pressures due to the wrong diagnosis of the cause of hypotension. The patient ended up with iatrogenic normal saline toxicity. Conclusion: It is important for healthcare professionals to recognize signs and symptoms of normal saline toxicities especially in elderly patients with many chronic illnesses. Hypotension treated with continuous normal saline will eventually led to hyperchloremic metabolic acidosis with edema from third spacing in patients with low albumin secondary to malnutrition. | |
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Keywords:
Hyperchloremic metabolic acidosis, Malnutrition, Normal saline, Toxicity
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Author Contributions
Muhammad Uneib – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Parin Rimtepathip – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Harold P. Katner – Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published |
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Guarantor of submission
The corresponding author is the guarantor of submission. |
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Source of support
None |
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Conflict of interest
Authors declare no conflict of interest. |
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Copyright
© 2015 Muhammad Uneib et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information. |
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