The Second Department of Internal Medicine, University of Toyama, Japan.
Intern Med. 2023 Apr 1;62(7):1031-1035. doi: 10.2169/internalmedicine.0126-22. Epub 2022 Sep 6.
A 47-year-old man was complaining of consciousness disorder. He had acute kidney injury, hypokalemia, and severe metabolic alkalosis. Initial treatment using intravenous infusion of 0.9% saline and potassium chloride improved his consciousness. It was clarified that he was a severe alcohol abuser who habitually self-vomited. We diagnosed him with volume depletion and pseudo-Bartter's syndrome due to loss of chloride by habitual vomiting. Gastrointestinal endoscopy demonstrated pyloric stenosis, which was ameliorated by Helicobacter pylori eradication therapy. We should consider volume depletion and pseudo-Bartter's syndrome as differential diagnoses when we encounter patients with acute kidney injury and severe metabolic alkalosis.
一位 47 岁男性因意识障碍就诊。他患有急性肾损伤、低钾血症和严重代谢性碱中毒。初始治疗采用静脉输注 0.9%生理盐水和氯化钾，改善了他的意识。经询问得知，该患者是一名重度酒精滥用者，习惯自行催吐。我们诊断其因习惯性呕吐导致氯离子丢失引起容量不足和假性巴特氏综合征。胃镜检查发现幽门狭窄，经幽门螺杆菌根除治疗后得到改善。当遇到急性肾损伤和严重代谢性碱中毒的患者时，我们应考虑容量不足和假性巴特氏综合征作为鉴别诊断。
