急诊科严重多因素代谢性碱中毒：一例报告

Severe Multifactorial Metabolic Alkalosis in the Emergency Department: A Case Report.

作者信息

Lukomskyj Alissa O, Partyka Christopher L

机构信息

Emergency Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

Emergency Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Aeromedical Operations, NSW Ambulance, Bankstown Airport, New South Wales, Australia.

出版信息

J Emerg Med. 2024 Jan;66(1):e33-e37. doi: 10.1016/j.jemermed.2023.08.009. Epub 2023 Aug 25.

DOI:10.1016/j.jemermed.2023.08.009

PMID:37867035

Abstract

BACKGROUND

Metabolic alkalosis is an uncommon clinical entity resulting from a wide variety of underlying etiologies including gastrointestinal, renal, endocrine, and metabolic causes. It is a typically clinically silent condition; however, severe cases can be life-threatening, mandating both a systematic investigative approach and an early aggressive management strategy.

CASE REPORT

We present a case of a 58-year-old man with severe, multifactorial metabolic alkalosis (pH 7.72, HCO 42 mmol/L, pCO 31 mm Hg) resulting from refractory vomiting, severe hypokalemia (2.0 mmol/L), and hypoalbuminemia (albumin 20 g/L). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Severe metabolic alkalosis is associated with significant morbidity and mortality. Clinicians need to be aware of the potential underlying causes in these cases, as well as how to delineate between chloride- and non-chloride-depleted states, which dictates initial treatment. We provide a pragmatic summary of the evaluation, pertinent investigations, and early management of these cases.

摘要

背景

代谢性碱中毒是一种不常见的临床病症，由多种潜在病因引起，包括胃肠道、肾脏、内分泌和代谢方面的原因。它通常在临床上没有明显症状；然而，严重的病例可能危及生命，这就需要系统的调查方法和早期积极的管理策略。

病例报告

我们报告一例58岁男性患者，患有严重的多因素代谢性碱中毒（pH 7.72，HCO 42 mmol/L，pCO 31 mmHg），病因是顽固性呕吐、严重低钾血症（2.0 mmol/L）和低白蛋白血症（白蛋白20 g/L）。急诊医生为何应了解此病症？：严重的代谢性碱中毒与显著的发病率和死亡率相关。临床医生需要了解这些病例潜在的病因，以及如何区分氯缺乏和非氯缺乏状态，这决定了初始治疗方案。我们对这些病例的评估、相关检查和早期管理进行了实用总结。