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Cholestyramine induced hyperchloremic metabolic acidosis.
Australian and New Zealand Journal of Medicine
|October 1, 1984
Summary
This case report details a 70-year-old woman who developed hyperchloremic metabolic acidosis after taking cholestyramine. Treatment with sodium bicarbonate successfully corrected the acidosis, highlighting a potential adverse effect of this medication.
Area of Science:
- Nephrology
- Gastroenterology
- Internal Medicine
Background:
- Primary biliary cirrhosis is a chronic liver disease.
- Cholestyramine is a bile acid sequestrant used to treat pruritus and hyperlipidemia.
Observation:
- A 70-year-old female with primary biliary cirrhosis presented with confusion and lethargy.
- She had been taking cholestyramine for two months.
- Physical examination revealed jaundice, signs of chronic liver disease, portal hypertension, and hepatic encephalopathy.
Findings:
- Laboratory results showed metabolic acidosis (pH 7.15) and hyperchloremia.
- Renal tubular acidosis was excluded.
- The patient's condition rapidly improved with intravenous sodium bicarbonate, normalizing mentation and electrolytes.
Implications:
- This is the first reported adult case of cholestyramine-induced hyperchloremic metabolic acidosis.
- It suggests a potential adverse effect of cholestyramine in adults, similar to pediatric reports.
- Prompt recognition and treatment with sodium bicarbonate are crucial for managing this condition.