Blank M J, Lew S Q
Department of Medicine, George Washington University Medical Center, Washington, D.C.
Blood Purif. 1991;9(2):109-13. doi: 10.1159/000170004.
A patient with end-stage renal disease (ESRD) developed metabolic alkalosis and alkalemia from protracted vomiting. As a result of the absence of the alkali excretory capacity in this patient with ESRD, the alkaline load accumulated rapidly. Once the amount of acid lost from vomiting exceeded the amount of acid gained from metabolism, alkalemia supervened. The initial arterial blood gas on room air revealed hypercarbia, hypoxia and alkalemia. Her serum bicarbonate was greater than 50 mEq/l. Compensatory hypoventilation occurred. In this report, the extent of compensatory hypoventilation in the setting of metabolic alkalosis in patients treated for ESRD and therapeutic approaches to this problem will be discussed. Treatment was aimed at correcting the primary disorder, namely metabolic alkalosis. Conventional bicarbonate dialysis was shown to be effective in improving acid-base homeostasis in this patient.
一名终末期肾病（ESRD）患者因长期呕吐出现代谢性碱中毒和碱血症。由于该ESRD患者缺乏碱排泄能力，碱性负荷迅速累积。一旦呕吐导致的酸丢失量超过代谢产生的酸摄入量，碱血症就会出现。在室内空气中测得的初始动脉血气显示存在高碳酸血症、低氧血症和碱血症。她的血清碳酸氢盐大于50 mEq/L。出现了代偿性通气不足。在本报告中，将讨论ESRD患者代谢性碱中毒情况下代偿性通气不足的程度以及针对该问题的治疗方法。治疗旨在纠正原发性疾病，即代谢性碱中毒。传统的碳酸氢盐透析被证明对改善该患者的酸碱平衡有效。
