Eovaldi Benjamin, Zanetti Claude
OMS IV, Downers Grove, IL 60615-1235, USA.
J Am Osteopath Assoc. 2011 May;111(5):344-5.
While acid-base disturbances are known to occur with chronic pancreatitis, few cases have been reported in which non-anion gap metabolic acidosis is caused by pancreaticopleural fistula, a known complication of chronic pancreatitis. The current report describes the case of a 49-year-old African American woman who presented with severe pleuritic chest pain and dyspnea at rest. The patient had a history of alcohol-induced chronic pancreatitis. Her chest radiograph was positive for a large left-sided pleural effusion. Magnetic resonance cholangiopancreatography revealed a small connection between the pancreas and the thoracic cavity. Arterial blood gas analysis revealed non-anion gap metabolic acidosis in the absence of substantial urinary or diarrheal bicarbonate losses. The patient was diagnosed as having non-anion gap metabolic acidosis as a result of a pancreaticopleural fistula and was successfully treated with pancreatic ductal stent placement by means of endoscopic retrograde cholangiopancreatography.
虽然已知酸碱紊乱会在慢性胰腺炎中发生，但由胰胸膜瘘（慢性胰腺炎的一种已知并发症）导致非阴离子间隙代谢性酸中毒的病例报告却很少。本报告描述了一名49岁非裔美国女性的病例，该患者出现严重的胸膜炎性胸痛和静息时呼吸困难。患者有酒精性慢性胰腺炎病史。她的胸部X光片显示左侧大量胸腔积液呈阳性。磁共振胰胆管造影显示胰腺与胸腔之间有一个小的连接。动脉血气分析显示在没有大量尿液或腹泻性碳酸氢盐丢失的情况下存在非阴离子间隙代谢性酸中毒。该患者被诊断为因胰胸膜瘘导致非阴离子间隙代谢性酸中毒，并通过内镜逆行胰胆管造影术成功进行了胰管支架置入治疗。
