Urinary Diversion and Metabolic Acidosis: A Case Report

Area of Science:

• Nephrology
• Urology
• Critical Care Medicine

Background:

• Urinary diversion is a surgical procedure to reroute urine flow, often after cystectomy for bladder cancer.
• Complications of urinary diversion pose significant challenges in clinical practice.
• Early identification of these complications is vital for reducing patient mortality and morbidity.

Observation:

• A 45-year-old male with a history of type 2 diabetes mellitus and hypertension presented with hematuria post-urinary diversion.
• The patient exhibited signs of dehydration, tachycardia, and laboratory findings indicative of acute kidney injury and hyperchloremic metabolic acidosis.
• Renal ultrasound revealed bilateral distended renal calyces, and bladder irrigation showed significant clot burden.

Findings:

• The patient was diagnosed with acute kidney injury and hyperchloremic metabolic acidosis following urinary diversion surgery.
• Treatment involved sodium bicarbonate infusion, antibiotics, and urinary catheterization for monitoring.
• The patient's condition improved with correction of laboratory parameters and he was transferred out of the surgical intensive care unit.

Implications:

• This case highlights the association between urinary diversion and the development of hyperchloremic metabolic acidosis.
• Physicians should maintain a high index of suspicion for this complication in patients with urinary diversion.
• Prompt diagnosis and appropriate management are essential for favorable outcomes in patients experiencing post-urinary diversion acidosis.