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Abstract: FR-PO608

Severe Chloride Deficiency Metabolic Alkalosis from Excessive Sweating

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 901 Fluid and Electrolytes: Basic

Authors

  • Yerneni, Himabindu, Dartmouth Hitchcock medical center, Hanover, New Hampshire, United States
  • Sedlacek, Martin, Dartmouth-Hitchock Medical Center, Lebanon, New Hampshire, United States
  • Oyadomari, Tomonori A., Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, United States
Introduction

Most cases of chloride deficiency metabolic alkalosis are due to chloride loss from the gastrointestinal tract or the urine and secondary hyperaldosteronism contributes to hypokalemia.We are presenting a case of chloride deficient metabolic alkalosis from an unusual source.

Case Description

A 32 y/o man presented with generalized weakness, fatigue and failure to thrive since several days. He was severely volume depleted with hypotension and orthostatic BP changes, subjective weight loss and decreased skin turgor. Laboratory testing revealed a severe hypokalemic metabolic alkalosis with CO2 50 mmol/L, Chloride 70 mmol/L, sodium 126 mmol/L, potassium 2.1 mmol/L, magnesium 0.78 mmol/l BUN 18 mg/dl creatinine 0.7 mg/dl. A spot urine sodium was 10 mmol/L, Chloride <10 mmol/L and potassium 26 mmol/L . The patient had no nausea, vomiting or diarrhea and denied any use of diuretics. He had a history of multi substance abuse and incarceration and recently started working as a painter. The patient reported that painting under the hot roof in summer” was killing him”. He had previous care in our institution because of cystic fibrosis. The patient’s symptoms and metabolic abnormalities resolved with saline and the patient was discharged.

Discussion

Cystic fibrosis is an inherited disorder characterized by excessive chloride content in sweat with resulting pulmonary and gastrointestinal complications. Chloride deficiency metabolic alkalosis is a rare complication of cystic fibrosis precipitated by environmental stressors leading to excessive sweating, in this case by painting under a hot roof in summer.