Severe metabolic alkalosis with fludrocortisone therapy—a case report
Abstract. Background. We present an atypical case of severe metabolic alkalosis, not reported in the literature to date. Case Presentation. Owing to concerns of apneas and desaturation, a 75-year-old man presented to the emergency department with significantly deranged physiology: bicarbonate level...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health/LWW
2025-03-01
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| Series: | Emergency and Critical Care Medicine |
| Online Access: | http://journals.lww.com/10.1097/EC9.0000000000000124 |
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| author | Grace Williams Honor Hinxman |
| author_facet | Grace Williams Honor Hinxman |
| author_sort | Grace Williams |
| collection | DOAJ |
| description | Abstract. Background. We present an atypical case of severe metabolic alkalosis, not reported in the literature to date.
Case Presentation. Owing to concerns of apneas and desaturation, a 75-year-old man presented to the emergency department with significantly deranged physiology: bicarbonate level of 63.6 mmol/L, a base excess of 40.6, and a potassium concentration of 1.9 mmol/L.
Primary diagnoses included metabolic alkalosis secondary to fludrocortisone therapy with respiratory compensation, hypokalemia, and hypochloremia. He initially received potassium replacement with cardiac monitoring, followed by permissive hypercapnia in the intensive care unit. He received acetazolamide to further improve his acid-base status. The patient had a good outcome with gradual return of his pH and bicarbonate levels to baseline. He was then discharged.
Conclusion. Iatrogenic mineralocorticoid excess should be considered when the patient presents with significantly raised bicarbonate levels. When starting fludrocortisone, renal function needs to be diligently monitored due to risk of hypokalemia metabolic alkalosis. |
| format | Article |
| id | doaj-art-b69b734b1b8f4c4bae38c228f10fc725 |
| institution | OA Journals |
| issn | 2097-0617 2693-860X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Emergency and Critical Care Medicine |
| spelling | doaj-art-b69b734b1b8f4c4bae38c228f10fc7252025-08-20T01:54:16ZengWolters Kluwer Health/LWWEmergency and Critical Care Medicine2097-06172693-860X2025-03-0151576010.1097/EC9.0000000000000124202503000-00008Severe metabolic alkalosis with fludrocortisone therapy—a case reportGrace Williams0Honor Hinxman1a Department of Anaesthesia, Whittington Health, London, United Kingdomb Department of Anaesthesia, St Richard’s Hospital, Chichester, United Kingdom.Abstract. Background. We present an atypical case of severe metabolic alkalosis, not reported in the literature to date. Case Presentation. Owing to concerns of apneas and desaturation, a 75-year-old man presented to the emergency department with significantly deranged physiology: bicarbonate level of 63.6 mmol/L, a base excess of 40.6, and a potassium concentration of 1.9 mmol/L. Primary diagnoses included metabolic alkalosis secondary to fludrocortisone therapy with respiratory compensation, hypokalemia, and hypochloremia. He initially received potassium replacement with cardiac monitoring, followed by permissive hypercapnia in the intensive care unit. He received acetazolamide to further improve his acid-base status. The patient had a good outcome with gradual return of his pH and bicarbonate levels to baseline. He was then discharged. Conclusion. Iatrogenic mineralocorticoid excess should be considered when the patient presents with significantly raised bicarbonate levels. When starting fludrocortisone, renal function needs to be diligently monitored due to risk of hypokalemia metabolic alkalosis.http://journals.lww.com/10.1097/EC9.0000000000000124 |
| spellingShingle | Grace Williams Honor Hinxman Severe metabolic alkalosis with fludrocortisone therapy—a case report Emergency and Critical Care Medicine |
| title | Severe metabolic alkalosis with fludrocortisone therapy—a case report |
| title_full | Severe metabolic alkalosis with fludrocortisone therapy—a case report |
| title_fullStr | Severe metabolic alkalosis with fludrocortisone therapy—a case report |
| title_full_unstemmed | Severe metabolic alkalosis with fludrocortisone therapy—a case report |
| title_short | Severe metabolic alkalosis with fludrocortisone therapy—a case report |
| title_sort | severe metabolic alkalosis with fludrocortisone therapy a case report |
| url | http://journals.lww.com/10.1097/EC9.0000000000000124 |
| work_keys_str_mv | AT gracewilliams severemetabolicalkalosiswithfludrocortisonetherapyacasereport AT honorhinxman severemetabolicalkalosiswithfludrocortisonetherapyacasereport |