Metabolic Alkalosis From Unsuspected Ingestion: Use of Urine pH and Anion Gap
- Title
- Metabolic Alkalosis From Unsuspected Ingestion: Use of Urine pH and Anion Gap
- Author
- 한상웅
- Keywords
- Metabolic alkalosis; surreptitious; hypokalemia; hypovolemia; urine chloride; urine pH; urine anion gap
- Issue Date
- 2012-04
- Publisher
- W B SAUNDERS CO-ELSEVIER INC, 1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA
- Citation
- American journal of kidney diseases : the official journal of the National Kidney Foundation, 59, 4, 577-581
- Abstract
- Underlying causes of metabolic alkalosis may be evident from history, evaluation of effective circulatory volume, and measurement of urine chloride concentration. However, identification of causes may be difficult for certain conditions associated with clandestine behaviors, such as surreptitious vomiting, use of drugs or herbal supplements with mineralocorticoid activity, abuse of laxatives or diuretics, and long-term use of alkalis. In these circumstances, clinicians often are bewildered by unexplained metabolic alkalosis from an incomplete history or persistent deception by the patient, leading to misdiagnosis and poor outcome. We present a case of severe metabolic alkalosis and hypokalemia with a borderline urine chloride concentration in an alcoholic patient treated with a thiazide. The cause of the patient's metabolic alkalosis eventually was linked to surreptitious ingestion of baking soda. This case highlights the necessity of a high index of suspicion for the diverse clandestine behaviors that can cause metabolic alkalosis and the usefulness of urine pH and anion gap in its differential diagnosis. Am J Kidney Dis. 59(4): 577-581. (C) 2012 by the National Kidney Foundation, Inc.
- URI
- http://www.ajkd.org/article/S0272-6386(11)01697-0/pdfhttp://hdl.handle.net/20.500.11754/37893
- ISSN
- 0272-6386
- DOI
- 10.1053/j.ajkd.2011.11.033
- Appears in Collections:
- COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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