A Case of Cardiac Arrhythmia from Absorption of Normal Saline during Hysteroscopic Myomectomy.

We present a case of severe hypokalemia, metabolic acidosis, and arrhythmia after absorption of 2500 mL normal saline during a hysteroscopic myomectomy. The patient was a 36-year-old woman with abnormal uterine bleeding caused by a submucosal leiomyoma. She received a total of 3500 mL normal saline (2500 mL was absorbed via the uterus and 1000 mL given intravenously) during hysteroscopy. This resulted in hemodilution, electrolyte disturbances, and arrhythmia. She was treated with electrolyte replacement and closely monitored. Normal saline may result in severe metabolic derangements caused by hemodilution and hyperchloremic metabolic acidosis when used as a hysteroscopic distension medium even when adhering to the American Association of Gynecologic Laparoscopists guidelines.