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Severe acute metabolic alkalosis

B N Rama¹, J Varghese, G Genova

¹Creighton Cardiac Center, Omaha, NE 68131-2044.

The Nebraska Medical Journal

|June 1, 1993

Summary

This case report details a 34-year-old male with severe metabolic alkalosis, featuring unprecedented serum bicarbonate and PCO2 levels. Treatment involved intravenous saline and potassium chloride administration.

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Area of Science:

Nephrology
Internal Medicine
Critical Care Medicine

Background:

Metabolic alkalosis (MA) is an acid-base disturbance characterized by an increase in serum bicarbonate concentration.
Severe MA can lead to significant physiological derangements and requires prompt recognition and management.

Observation:

A 34-year-old male presented with severe metabolic alkalosis.
Peak serum bicarbonate (HCO3) was 96 mg/dL and compensatory partial pressure of carbon dioxide (PCO2) was 95 mmHg.
These levels represent, to our knowledge, the highest reported in a patient with MA.

Findings:

The MA was likely induced by excessive sodium bicarbonate intake and complicated by renal impairment.
Volume depletion, hypokalemia, and hyochloremia contributed to the maintenance of the alkalotic state.
Impaired renal function played a crucial role in the persistence of the severe MA.

Implications:

This case highlights the potential for extreme acid-base disturbances with high bicarbonate and PCO2 levels.
It underscores the importance of considering iatrogenic causes, such as sodium bicarbonate ingestion, in MA.
Successful management with intravenous saline and potassium chloride demonstrates a viable therapeutic approach for severe MA.

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