Abstract
Severe metabolic alkalosis is a potential life threatening disorder, which may pose some diagnostic and therapeutic problems. In this case report critical steps to diagnosis and therapeutic success are presented. The most common cause for metabolic alkalosis is vomiting which is associated with loss of chloride and hydrogen ions. The primary therapy is the correction of volume depletion and substitution of electrolyte imbalances. The need for application of protons by intravenous infusion of amino acids or hydrochloric acid is rare. The hydrochloric acid infusion requires a central venous vascular access. This catheter and the infusion itself has many severe complications.
In the presented case the application of a proton pump inhibitor had a good impact on symptoms, after initial volume administration and electrolyte substitution had failed as primary measures. The application of proton pump inhibitors seems to be a safe and successful alternative to hydrochloric or amino acid infusion in the treatment of severe metabolic alkalosis.
Zusammenfassung
Die schwere metabolische Alkalose stellt nicht selten ein diagnostisches und therapeutisches Problem dar. In einem kurzen Fallbeispiel werden die wichtigsten Ursachen und Differentialdiagnosen, sowie die möglichen Therapieoptionen vorgestellt. Die häufigste Ursache sind gastrointestinale Chlorid- und Wasserstoffionenverluste bei Erbrechen. Die wichtigste Therapie ist die Behandlung der Grunderkrankung und der Ausgleich von Volumen- und Elektrolytverlusten, ansäuernde Maßnahmen sind selten notwendig und komplikationsbehaftet. Die Gabe eines Protonenpumpenhemmers erwies sich in dem vorgestellten Fall als rasch wirksam, nachdem es unter Volumengabe und Elektrolytsubstitution zu einer nur langsamen Besserung der Symptomatik kam.
Die Gabe eines Protonenpumpenhemmers zur Therapie der chloridsensiblen metabolischen Alkalose stellt scheinbar eine sichere und rasch wirksame Behandlungsoption dar.
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Koball, S., Hinz, M., Gloger, M. et al. Die metabolische Alkalose – Diagnostik und Therapie. Intensivmed 45, 396–401 (2008). https://doi.org/10.1007/s00390-008-0875-1
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DOI: https://doi.org/10.1007/s00390-008-0875-1
Key words
- metabolic alkalosis
- potassium depletion
- chloride depletion
- acute renal failure
- proton pump inhibitor
- hypovolemia