Abstract: SA-PO493
Metabolic Acidosis in a Patient With Polycystic Ovary Syndrome Taking Oral Contraceptives and Antipsychotics
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid‚ Electrolyte‚ and Acid-Base Disorders
- 1002 Fluid‚ Electrolyte‚ and Acid-Base Disorders: Clinical
Author
- Tolani, Renuka, Palmetto General Hospital, Hialeah, Florida, United States
Introduction
Patients with insulin resistance such as with polycystic ovarian syndrome (PCOS) who are on oral contraceptives (OCPs) and antipsychotics, may be at an increased risk for hypertriglyceridemia as a side effect. Lipolysis of triglycerides may increase free fatty acid production and therefore contribute to HAGMA. When there is severe hypertriglyceridemia, then plasmapheresis and dialysis play an important role in resolution.
Case Description
An 18 year old female with a past medical history of PCOS, diabetes, and depression presented to the ED with lower abdominal pain. Her home medications included lurasidone, sertraline, ethinyl estradiol-norgestimate, metformin, and insulin. Patient complained of associated dysuria. In the ED patient was found with tachycardia and tachypnea, but normotensive and afebrile. Labs were notable for leukocytosis of 15.7, glucose 252, bicarb 6, anion gap 23, and sodium 128. BUN was 4 and creatinine was 0.6. There was not a significant osmolality gap. Lactic acid was not elevated. Acetaminophen, ethanol, and salicylate levels were negative. UA was significant for leukocyte esterase, protein, glucose, and ketones. Urine culture grew E coli. Blood gas on room air showed pH of 7.028, pCo2 10.3, bicarb 5, and paO2 130. Lipid panel showed cholesterol of 1,062, LDL < 472, and triglycerides > 2625. Lipase was 431, without findings of pancreatic pathology on CT abdomen. Hemoglobin A1C was found to be 9.81. The patient received a dialysis and plasmapheresis session. She was started on insulin drip, statin, omega and fenofibrate. She received 5 amps of bicarb and was started on a bicarb drip. She was given a course of antibiotics for her UTI. Over a course of 24 hours the acidosis resolved and the anion gap closed. Triglycerides reduced to the 400s by the next day. Trialysis catheter was removed. Psychiatry and internal medicine decided to discontinue antipsychotic and continue sertraline. She was discharged with OCP containing less estrogen, insulin, statin, omega-3 and fenofibrate.
Discussion
In patients with hypermetabolic syndrome who have HAGMA on labs, it is important to check for elevated triglycerides and treat based on severity. After plasmapharesis and hemodialysis with reduction of triglyceride levels, our patient's HAGMA resolved. There have been a few cases reported of oral contraception-induced hypertriglyceridemia particularly with estrogen, but requires further research.