Laglera S, Sánchez-Tirado J A, Rasal S, Martínez-Diestre M D, Lafuente F, Ruiz J
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Miguel Servet, Zaragoza.
Rev Esp Anestesiol Reanim. 2002 Dec;49(10):545-9.
A 63 year-old man with a history of anal carcinoma treated by surgery, chemotherapy and radiotherapy was admitted to our hospital two years later with small bowel obstruction requiring emergency surgery. Fifteen days later, he had to be operated on once again. During the procedure, severe metabolic alkalosis developed: pH 7.58, CO3H- 47.7 mmol/L and a base excess of 24.3 mmol/L. The patient had the following preoperative risk factors for hypochloremic metabolic alkalosis: low levels of Cl and K, prolonged aspiration of gastric contents, low plasma volume and parenteral nutrition. Metabolic alkalosis was managed with 250 mL of 7.5% hypertonic saline, 40 mEq of KCl, readjustment of the ventilatory pattern, perfusion of lactated Ringer's solution instead of 0.9% saline and administration of omeprazole. Response to treatment was good as elevated values fell to acceptable levels within two hours. Metabolic alkalosis is a common acid-base balance disorder which arises for a variety of reasons and which has significant anesthetic implications. Hypertonic saline may be useful for treating severe, acute hypochloremic metabolic alkalosis.
一名63岁男性，有肛管癌病史，接受过手术、化疗和放疗，两年后因小肠梗阻需急诊手术入住我院。15天后，他不得不再次接受手术。术中出现严重代谢性碱中毒：pH 7.58，碳酸氢根47.7 mmol/L，碱剩余24.3 mmol/L。该患者术前存在以下低氯性代谢性碱中毒的危险因素：氯和钾水平低、胃内容物长时间抽吸、血浆容量低和肠外营养。代谢性碱中毒的处理措施包括：静脉输注250 ml 7.5%高渗盐水、40 mEq氯化钾、调整通气模式、用乳酸林格液代替0.9%生理盐水进行灌注以及给予奥美拉唑。治疗反应良好，两小时内升高的值降至可接受水平。代谢性碱中毒是一种常见的酸碱平衡紊乱，其发生原因多种多样，且对麻醉有重要影响。高渗盐水可能有助于治疗严重的急性低氯性代谢性碱中毒。
