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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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