Hyporeninemic hypoaldosteronism after chronic sodium bicarbonate abuse

We describe a 52-year-old man who, following the discontinuation of massive intake of sodium bicarbonate, in the absence of renal insufficiency, developed progressive hyperkalemia and hyponatremia in association with hyporeninemic hypoaldosteronism. The mechanism of this syndrome is not known, but may involve suppression of the renin-angiotensin-aldosterone axis by chronic volume expansion.