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Abstract: TH-PO385

A Hidden Challenge: Metabolic Acidosis After Neobladder Surgery

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Vazquez-Fernandez, Paola M., Hospital Damas, Ponce, Puerto Rico
  • Ocasio Melendez, Ileana E., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Rivera Rios, Jeaneishka Marie, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Pacheco-Molina, Caleb Samuel, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Andujar-Rivera, Krystahl Z., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
Introduction

Neobladder construction is a surgical procedure involving the creation of a new bladder using intestinal segments. One complication is hyperchloremic metabolic acidosis, which occurs due to the continued exchange of electrolytes by the neobladder lumen. This complication is uncommon and may not be promptly identified by primary physicians.

Case Description

A 70-year-old man with urothelial cancer who underwent transurethral resection of bladder tumor, radical cystoprostatectomy, and neobladder construction. The patient experienced postoperative complications, including pneumonia and fungemia. One month later, he presented with weakness and a humming sensation in his ears. His medical history included hypertension and type 2 diabetes mellitus, and he was taking metformin and losartan. He denied experiencing diarrhea, using non-steroidal anti-inflammatory drugs, or having a prior history of renal disease. Vital signs showed blood pressure of 115/75 mmHg, heart rate 100 beats per minute, respiratory rate 19, oxygen saturation 98% at room air, and temperature 37°C. Physical examination revealed an acutely ill male in no distress, with dry oral mucosa and decreased skin turgor. Initial laboratory results revealed creatinine level 1.76 mg/dL (baseline creatinine 0.8 mg/dL), BUN level 62.0 mg/dL, chloride level 116 mmol/L, bicarbonate level 8.1 mmol/L, potassium level 5.54 mmol/L. Arterial blood gas values of pH 7.255, pCO2 14 mmHg, and pO2 100 mmHg. Normal anion gap metabolic acidosis with an anion gap of 9. The urinary anion gap was +23. The patient was initially treated with a bicarbonate drip, which was later transitioned to oral bicarbonate. Renal function improved, and the metabolic acidosis resolved. The patient was discharged with oral buffer therapy and scheduled for follow-up at the clinics.

Discussion

Hyperchloremic metabolic acidosis is a rare complication of neobladder reconstruction. The apical Cl-/HCO3- exchanger plays a key role in the development of acidosis. Although this can be transient, delayed diagnosis can lead to significant morbidity. Early identification allows for effective treatment with sodium bicarbonate. It is crucial to provide detailed and clear post-operative discharge documentation to ensure early recognition of such complications.