Abstract: PUB106
When Alkalosis Requires CRRT: A Case Report
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Author
- Abdulrahman, Rula A., Stony Brook Medicine, Stony Brook, New York, United States
Introduction
Severe metabolic alkalosis (MA) in the setting of volume overload and acute kidney injury (AKI) is uncommon and can be difficult to manage in clinical practice. Most patients with AKI typically present with metabolic acidosis, whereas MA is more commonly observed after initiation of CRRT specially when citrate anticoagulation is used. In this report, we present a case of severe MA associated with AKI and volume overload that is successfully managed with CRRT.
Case Description
78 y old female with chronic obstrutive lung disease (COPD), hypertension admitted to cardiac care unit with shortness of breath, weight gain, and bilateral lower extremities edema. Further testing revealed pulmonary embolism, right heart failure and volume overload. She was started on Lasix drip and diuril. Labs are shown in the table. On day 13, nephrology was consulted for sever MA and volume overload. She was on milrinone and leveophed drip,Diamox IV was added. The patient had severe MA with chronic respiratory acidosis
CVVHDF was initiated given sever metabolic derangement and poor urine output with volume overload. 2 days later electrolytes and ABG are almost normal as in the table
Discussion
Severe MA in the setting of AKI and volume overload is uncommon and difficult to manage. Unlike most AKI cases, which present with metabolic acidosis, this patient developed profound alkalosis due to aggressive diuresis with furosemide and chlorothiazide causing chloride and potassium depletion, along with chronic hypercapnia from COPD promoting bicarbonate retention. Conventional therapy, including reduction of diuretics and acetazolamide, was limited because the patient remained markedly volume overloaded and oliguria , making isotonic saline administration unsafe. Continuous renal replacement therapy (CRRT) provided an effective alternative by allowing gradual correction of acid-base and electrolyte abnormalities while simultaneously achieving controlled ultrafiltration. Following CRRT initiation, bicarbonate level, serum chloride and pH improved rapidly. This case highlights the important role of CRRT in managing severe MA when conventional therapy is limited by concurrent AKI, oliguria, and volume overload.