An Intraoperative Episode of Severe Type II Renal Tubular Acidosis in an 83-Year-Old Woman

Type II renal tubular acidosis (RTA) is a rare defect in bicarbonate transport that can cause serious metabolic derangements. We report the case of a spontaneous, isolated intraoperative episode of severe type II RTA in an elderly woman who presented for radical neck dissection, mandible excision, and flap creation. Intraoperatively, she developed a stark metabolic acidosis with hypokalemia, progressively worsening base excess, and prolific urine output. Aggressive resuscitation with bicarbonate corrected all metabolic abnormalities. There was no identifiable trigger and the patient was successfully discharged with no further recurrences during hospitalization. The inability to identify the clinical presentation of RTA perioperatively can lead to poor outcomes.