Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 12 ( 2018 ) > List of Articles


Extreme metabolic alkalosis and acute kidney injury in a 38-year-old male patient

Johannes Heymer, Andreas Lienig, Joachim Löffler, Tobias Schilling, Daniel Räpple

Keywords : Duodenal stenosis, metabolic alkalosis, vomiting

Citation Information : Heymer J, Lienig A, Löffler J, Schilling T, Räpple D. Extreme metabolic alkalosis and acute kidney injury in a 38-year-old male patient. Indian J Crit Care Med 2018; 22 (12):883-885.

DOI: 10.4103/ijccm.IJCCM_180_18

License: CC BY-ND 3.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Repeated vomiting may lead to profound loss of fluid and electrolytes. We describe a case with life-threatening acid-base disturbances due to vomiting. A 38-year-old man presented to an emergency department with weakness and decreased urine output after having vomited up to 20 times per day over a period of 7 days. Arterial blood gas analysis revealed a metabolic alkalosis with partial respiratory compensation. Initial management consisted of oxygen therapy and intravenous fluid therapy with normal saline and potassium chloride. To prevent further gastric losses of HCl, proton-pump inhibitors and metoclopramide were administered. The vomiting was caused most likely by a temporary duodenal stenosis due to portal hypertension of unknown etiology. In our opinion, this case demonstrates the successful management of a life-threatening condition by simple measures. Despite extensive diagnostic procedures, the effective treatment of the underlying condition consisted of watchful waiting.

PDF Share
  1. Bae EH, Ma SK, Kim SW. Extreme metabolic alkalosis caused by gastrostomy tube malposition treated using conventional hemodialysis. Chonnam Med J 2016;52:217-8.
  2. Galla JH. Disease of the month metabolic alkalosis classification and definitions. J Am Soc Nephrol 2000;1:369-75.
  3. Hsu SC, Wang MC, Liu HL, Tsai MC, Huang JJ. Extreme metabolic alkalosis treated with normal bicarbonate hemodialysis. Am J Kidney Dis 2001;37:E31.
  4. Ryuge A, Matsui K, Shibagaki Y. Hyponatremic chloride-depletion metabolic alkalosis successfully treated with high cation-gap amino acid. Intern Med 2016;55:1765-7.
  5. Soliz J, Lim J, Zheng G. Anesthetic management of a patient with sustained severe metabolic alkalosis and electrolyte abnormalities caused by ingestion of baking soda. Case Rep Anesthesiol 2014;2014:930153.
  6. Jukes A, Gunew M, Marshall R. Severe muscle fasciculations and tremor in a cat with hypochloraemic metabolic alkalosis secondary to duodenal obstruction. JFMS Open Rep 2017;3:1-4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.