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

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

doi:10.4103/ijccm.IJCCM_180_18

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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: 01-12-2018

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Abstract

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.

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