Niederstadt C, Kurowski V, Djonlagic H
Intensivstation der Klinik für Innere Medizin, Medizinische Universität Lübeck.
Dtsch Med Wochenschr. 1996 Aug 2;121(31-32):978-82. doi: 10.1055/s-2008-1043095.
A 47-year-old man in a reduced general condition, presumed to be a chronic alcoholic, was hospitalised in a sleepy state and impaired level of consciousness (Glasgow Coma Scale 8). There were no focal neurological deficits, but all proprioceptor reflexes were weak. Body temperature was 36.8 degrees C, blood pressure 90/60 mm Hg, and heart rate 80/min.
Biochemical tests showed sodium concentration reduced to 121 mmol/l, potassium to 1.83 mmol/l, chloride to 55 mmol/l and, on the next day, phosphate to 0.11 mmol/l. Blood gas analysis demonstrated a noncompensated respiratory alkalosis (pH 7.69, bicarbonate 39.5 mmol/l and a base excess of 20 mmol/l.
The impaired consciousness was thought to be due to the marked alkalosis in combination with hypophosphataemia. The alkalosis was completely removed within 48 hours by administration of Ringer's solution and potassium chloride concentrate, without sodium chloride Phosphate deficit was neutralised with KH2PO4 infusion. Normal consciousness was restored.
Even severe hypochloraemic alkalosis can be quickly reversed with infusion of chloride without sodium Successful treatment with chloride alone excludes alkalosis induced by mineralocorticoids.
一名47岁男性，全身状况较差，推测为慢性酒精中毒患者，因嗜睡及意识水平受损（格拉斯哥昏迷量表评分为8分）入院。无局灶性神经功能缺损，但所有本体感觉反射均减弱。体温36.8℃，血压90/60mmHg，心率80次/分钟。
生化检查显示，钠浓度降至121mmol/L，钾降至1.83mmol/L，氯降至55mmol/L，次日磷酸盐降至0.11mmol/L。血气分析显示为未代偿性呼吸性碱中毒（pH7.69，碳酸氢盐39.5mmol/L，碱剩余20mmol/L）。
意识障碍被认为是由于明显的碱中毒合并低磷血症所致。通过输注林格液和氯化钾浓缩液，在48小时内完全纠正了碱中毒，未输注氯化钠。通过输注KH2PO4纠正了磷酸盐缺乏。意识恢复正常。
即使是严重的低氯性碱中毒，通过输注不含钠的氯化物也可迅速纠正。单独使用氯化物成功治疗可排除由盐皮质激素引起的碱中毒。
