Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation

Area of Science:

• Internal Medicine
• Nephrology
• Pulmonology

Background:

• Metabolic alkalosis can rarely cause compensatory hypoventilation and hypercapnia.
• Gastric outlet obstruction is a known cause of metabolic alkalosis due to gastric acid loss.

Observation:

• A patient with gastric outlet obstruction presented with severe hypochloremic metabolic alkalosis, coma, hypoventilation, and hypercapnia.
• This presentation is rare, with no prior English literature reports of such severe respiratory acidosis or hypochloremia in this context.

Findings:

• The patient survived after emergency treatment.
• The case highlights an unusual but severe manifestation of metabolic alkalosis secondary to gastric losses.

Implications:

• Accurate understanding of the pathophysiology of metabolic alkalosis from gastric losses is crucial.
• Prompt correction of acid-base abnormalities is necessary to restore normal alveolar ventilation and prevent severe complications.