Hirai Kenta, Nagai Kei, Ono Takashi, Nakajima Masayuki, Hayakawa Tomohiro, Sakata Yoshinori, Nakamura Yoshiharu
Kamisu Saiseikai Hospital, Japan.
J Rural Med. 2021 Jan;16(1):47-51. doi: 10.2185/jrm.2020-025. Epub 2021 Jan 5.
Most cases of severe metabolic alkalosis have many causes that may result in renal failure and death. Therefore, these should be treated promptly for successful recovery. A 61-year-old man was hospitalized due to an acute kidney injury (creatinine level of 4.36 mg/dL) after a 3-month history of anorexia and recurrent vomiting. He had been treated for tuberculosis in the past. Blood gas analysis revealed severe metabolic alkalosis with pH=7.66, HCO=94 mmol/L, and pCO=82.0 mmHg. Routine biochemical examination revealed severe hypokalemia (K 2.9 mEq/L) that was associated with prolonged QTc interval (0.52 seconds) on the electrocardiogram. Gastrofiberscopic examination also revealed severe stenosis and ulcerated scarring of the gastric pylorus and severe esophagitis. Intravenous hydration and correction of hypokalemia improved renal function and resolved metabolic alkalosis. An investigation that was repeated after 6 days revealed a creatinine level of 1.58 mg/dL, pH=7.47, HCO=23.4 mmol/L, K=3.6 mEq/L, and QTc of 0.45 seconds. The patient underwent gastrectomy and adenocarcinoma was observed. We described a resolved case of severe metabolic alkalosis and acute kidney injury in a rural medical setting following conservative management.
大多数严重代谢性碱中毒病例有多种病因，可能导致肾衰竭和死亡。因此，应迅速进行治疗以成功康复。一名61岁男性因厌食和反复呕吐3个月后出现急性肾损伤（肌酐水平为4.36mg/dL）而住院。他过去曾接受过结核病治疗。血气分析显示严重代谢性碱中毒，pH=7.66，HCO=94mmol/L，pCO=82.0mmHg。常规生化检查显示严重低钾血症（血钾2.9mEq/L），心电图显示QTc间期延长（0.52秒）。胃镜检查还显示胃幽门严重狭窄和溃疡瘢痕形成以及严重食管炎。静脉补液和纠正低钾血症改善了肾功能并纠正了代谢性碱中毒。6天后复查显示肌酐水平为1.58mg/dL，pH=7.47，HCO=23.4mmol/L，血钾=3.6mEq/L，QTc为0.45秒。患者接受了胃切除术，观察到腺癌。我们描述了在农村医疗环境中经保守治疗后痊愈的严重代谢性碱中毒和急性肾损伤病例。
