Hypernatremic chloride-depletion metabolic alkalosis successfully treated with high cation-gap amino acids: a case report

Akihiro Ryuge; Shogo Nagamine; Masashi Saito; Naoki Matsumoto; Marina Asano

doi:10.1007/s13730-023-00837-z

Hypernatremic chloride-depletion metabolic alkalosis successfully treated with high cation-gap amino acids: a case report

CEN Case Rep. 2023 Nov 22. doi: 10.1007/s13730-023-00837-z. Online ahead of print.

Authors

Akihiro Ryuge¹, Shogo Nagamine², Masashi Saito³, Naoki Matsumoto², Marina Asano²

Affiliations

¹ Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan. ryuge0120@yahoo.co.jp.
² Department of Nephrology, National Hospital Organization Nagoya Medical Center, 1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
³ Department of Gastroenterology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.

PMID: 37991678
DOI: 10.1007/s13730-023-00837-z

Abstract

Normal saline (NS) is recommended for the treatment of chloride-depletion alkalosis (CDA). However, its use in patients with drinking water restrictions or fluid volume deficiencies may lead to hypernatremia. We report the case of a 42-year-old Japanese man with ileus due to sigmoidal volvulus, who presented with CDA. After endoscopic decompression, NS was administered to treat the CDA. Despite the administration of NS, CDA persisted and hypernatremia developed. The infusion was then changed to high cation-gap amino acids (HCG-AA), which improved both metabolic alkalosis and hypernatremia. Thus, HCG-AA may be useful for the treatment of hypernatremia in patients with CDA.

Keywords: Chloride-depletion alkalosis; High cation-gap amino acid; Hypernatremia.