Acute Respiratory Distress and Hyperchloremic Metabolic Acidosis as a Result of Massive Irrigation Fluid Extravasation After Arthroscopic Shoulder Surgery: A Case Report and Recommendations for Preventable Complications

Patient: Female, 68-year-old Final Diagnosis: Pleural effusion Symptoms: Breathlessness • shortness of breath Medication: — Clinical Procedure: Arthroscopic Rotator Cuff repair Specialty: Orthopedics and Traumatology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: Airway compromise caused by massive fluid extravasation in association with arthroscopic shoulder surgery is rare. However, it is even more rare to occur as a result of pleural effusion. We present this case to increase the awareness of this rare complication and show how to minimize the likelihood of this uncommon incident. CASE REPORT: We describe a case of a 68-year-old woman who underwent elective shoulder arthroscopy for rotator cuff repair. She had immediate postoperative shortness of breath and was found to have bilateral pulmonary edema and pleural effusion accompanied by metabolic acidosis. She was managed conservatively in the intensive care unit and then transferred to the general ward after clinical and radiological improvement the next day. CONCLUSIONS: This uncommon complication was self-limiting, and the patient recovered uneventfully. High clinical suspicion is required to address this event so proper rapid management can be made.