Abstract
Introduciton: 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 nonanion 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.
Highlights
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
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
We describe a case of 63 years old Caucasian female with a history of schizophrenia, traumatic brain encephalopathy, and chronic kidney disease stage III, who presented to the emergency department from a nursing home due to altered mental status with hypotension
Summary
Infusing large volumes of 0.9% sodium chloride (saline) to patients can cause toxicities of both hyperchloremic metabolic acidosis and edema of the surrounding tissues [1]. Malnutrition and dehydration present very similar among the elderly patients, especially those with altered mental status and underlying causes such as psychiatric disturbances, stroke, or chronically ill. We describe a case of 63 years old Caucasian female with a history of schizophrenia, traumatic brain encephalopathy, and chronic kidney disease stage III, who presented to the emergency department from a nursing home due to altered mental status with hypotension. A 63-year-old Caucasian female with history of schizophrenia, traumatic brain encephalopathy, and chronic kidney disease stage III, presented to the emergency department due to altered mental status and a decline in blood pressures. On day-4, infection disease department was consulted due to failure of improvement of the blood pressure despite antibiotic treatment with additional onset of pitting edema and new findings on the CT scan. Patient was considered for peg tube placement for malnutrition with stoppage of the 0.9% normal saline due to normal saline toxicity
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