Successful Treatment of Life-Threatening Metabolic Alkalosis Due to Pyloric Stenosis: A Rare Case

Abstract

Alkalemia is defined as blood pH > 7.40 and if severe alkalemia pH > 7.60. Metabolic alkalosis is one of the common in-hospital acid-base disorders. Gastric outlet obstruction secondary to pyloric stenosis has been reported most frequent causes of severe metabolic alkalosis resulting from volume and hydrogen ion loss. Mortality is directly related to the severity of the acid base disturbances. As serum pH exceeds 7.60, the mortality also increases and can reach up to 80%. The current case is of a 41-year-old male with history of peptic ulcer disease presented with muscle cramps and confusion, and found to have severe metabolic alkalosis with an arterial pH of 7.91 mm Hg . He had superimposed acute kidney injury and severe hypokalemia which was successfully treated with aggressive volume repletion, hydrochloric acid infusion and surgery for pyloric stenosis. This is the severe reported life compatible level of metabolic alkalosis (pH: 7.91) to best our knowledge. J Med Cases. 2014;5(5):312-314 doi: http://dx.doi.org/ 10.14740 / jmc1623w