‘A Perfect Example of the Strong Ion Difference: Hyperchloraemic Acidosis Due To 0.9% Normal Saline Irrigation, in A Patient With A Ruptured Bladder’ - ‘A Perfect Example of the Strong Ion Difference: Hyperchloraemic Acidosis Due To 0.9% Normal Saline Irrigation, in A Patient With A Ruptured Bladder’ - Open Access Pub

An 81-year-old male presented to the Emergency Department with urinary retention, subsequent to passing blood clots. A three-way catheter was inserted for continuous bladder irrigation. 48 hours later he deteriorated, with worsening tachypnea and hypoxaemia. Clinical examination and chest x-ray suggested pulmonary odema, managed with intravenous furosemide, and non-invasive ventilation. His irrigation circuit-chart showed he had received 10 litres Normal Saline via the afferent limb, but only 3 litres recorded at the efferent limb. It was suspected the catheter was adjacent to a vascular-cystic interface, however an urgent contrast CT revealed the irrigating catheter perforating the bladder, being situated in the abdominal cavity (see 3 images). His arterial blood-gas analysis demonstrated the expected normal anion-gap academia, however his Strong Ion Difference calculations, sodium-chloride difference of 13 and a normal albumin level, perfectly demonstrated the expected calculated BE of -13. The catheter was withdrawn, and the patient made a full recovery. DOI10.14302/issn.2641-5518.jcci-19-2909 Disorders of the renal tract can often lead to biochemical abnormalities, due the kidneys being the predominant organ of this system. 1 Common disorders of the renal tract often present with a metabolic acidosis due to the renal handling of various electrolytes, and the specific cellular pump mechanisms within the kidney. However, the metabolic acidosis is usually a high-anion gap acidosis due to the accumulation of phosphate and sulphate ions within the plasma, leading to a depletion in serum bicarbonate. We present a patient with an iatrogenic disorder of the genitourinary tract that presented with a severe normal anion gap acidosis, and serum biochemistry that demonstrated the potential use of calculating the strong ion difference. An 81-year-old male presented with to the Emergency Department with urinary retention subsequent to passing blood clots. His urine-flow had been becoming increasingly difficult over the past few months, and he had a recent history of being treated with antibiotics for a urinary tract infection by his General Practitioner. He had a background medical history of benign prostatic hypertrophy, and ischaemic heart disease, although he had not reported any cardiovascular symptoms for many years. He was extremely independent and actively engaged in farming. There was no history of recent trauma to the abdomen or bladder, and his history. It was felt that his presentation was due to haemorrhagic cystitis subsequent to his urinary tract