Severe hypokalaemic metabolic alkalosis following ingestion of gaviscon.
BACKGROUND
Uncommon metabolic abnormalities in the emergency department could be a result of drug overdose due to uncommon agents.


METHODS
A 35-year-old male presented to the emergency department with a Glasgow Coma Scale (GCS) of 3/15 and a normal pulse rate and blood pressure. Subsequent questioning after recovery revealed he had ingested 2 L of Gaviscon over the preceding 48 hours. He had normal haematology, liver, and renal function during admission. The electrocardiogram showed T wave inversion in the inferior leads on admission. Arterial blood gas on air was: pH 7.54, HCO3 50 mmol/L (50 meq/L), Chloride 66 mmol/L, anion gap was 19, pO2 11 kPa (82.5 mmHg), and pCO2 8 kPa (60 mmHg). Serum sodium was 127 mmol/L and serum potassium was 1.6 mmol/L. His GCS improved within one hour of admission with supportive care, and his serum potassium and bicarbonate improved within 24 hours. He subsequently made a full recovery. Discussion. Bicarbonate ingestion in the form of Gaviscon(R) and vomiting made this patient alkalotic, and simple supportive care provided effective management with a complete recovery.


CONCLUSIONS
This case illustrates how a severe metabolic alkalosis can result from a significant ingestion of Gaviscon, and that such presentations can give rise to diagnostic dilemma.
Gawarammana
I B
IB
Guy's Poison Unit, Guy's and St. Thomas', NHS Foundation Trust. London, United Kingdom. indikagawarammana@yahoo.com
Coburn
J
J
Greene
S
S
Dargan
P I
PI
Jones
A L
AL
D000328:Adult; D000464:Alginates / Q000506:poisoning*; D000471:Alkalosis / Q000139:chemically induced / Q000628:therapy; D000536:Aluminum Hydroxide / Q000506:poisoning*; D000863:Antacids / Q000506:poisoning*; D004338:Drug Combinations; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced / Q000628:therapy; D008297:Male; D012720:Severity of Illness Index; D012824:Silicic Acid / Q000506:poisoning*; D017693:Sodium Bicarbonate / Q000506:poisoning*; D016896:Treatment Outcome
D000464:Alginates; D000863:Antacids; D004338:Drug Combinations; D012824:Silicic Acid; D000536:Aluminum Hydroxide; C007829:alginate, aluminium hydroxide, magnesium trisilicate, sodium bicarbonate drug combination; D017693:Sodium Bicarbonate