Division of Nephrology, University of Utah, Salt Lake City, Utah, USA.
Division of Nephrology, Lincoln Medical Center, New York City Health and Hospitals, New York, New York, USA.
Hemodial Int. 2022 Apr;26(2):E16-E18. doi: 10.1111/hdi.12984. Epub 2021 Dec 14.
Severe metabolic alkalosis is rarely seen in end stage renal disease (ESRD) patients on long-term hemodialysis. This can be life threatening and mortality is exponentially increased when the pH exceeds 7.60. Persistent vomiting, ingestion of alkali for dyspepsia and pica behavior are all potential causes of such severe metabolic alkalosis. The prevalence of pica is increased in chronic kidney disease and ESRD patients, with ice being the most commonly ingested substance. It can cause a myriad of complications including death, but the diagnosis may be elusive unless the pica behavior is witnessed firsthand by others since patients do not typically disclose their behavior. We present the case of a hemodialysis patient with severe alkalemia, hypernatremia, and excessive interdialytic weight gains resulting in recurrent hospitalizations for fluid overload due to baking soda pica behavior.
严重代谢性碱中毒在长期接受血液透析的终末期肾病（ESRD）患者中很少见。当 pH 值超过 7.60 时，这种情况可能会危及生命，死亡率呈指数级增加。持续性呕吐、摄入碱性物质治疗消化不良和异食癖行为都是导致这种严重代谢性碱中毒的潜在原因。异食癖在慢性肾脏病和 ESRD 患者中更为常见，其中最常摄入的物质是冰。它会导致许多并发症，包括死亡，但如果没有亲眼目睹患者的异食癖行为，诊断可能会很困难，因为患者通常不会透露自己的行为。我们报告了一例血液透析患者出现严重碱中毒、高钠血症和透析间期体重过度增加，导致因异食癖行为摄入小苏打而反复发生液体超负荷住院。
