The McKittrick-Wheelock syndrome: a case of acute renal failure due to neoplastic cholera.
The McKittrick-Wheelock syndrome is characterized by severe electrolyte and fluid depletion as a result of rectal tumor hypersecretion. Typically, a metabolic acidosis ensues. We report the case of a 58-year-old man who presented with a mixed metabolic acidosis and alkalosis. He was hyponatremic, hypokalemic, and hypochloremic, with acute renal failure on blood testing. Following fluid resuscitation, a predominant alkalemia was observed. The patient was found to be passing 1.5 L of mucous per rectum per day, containing high concentrations of sodium and potassium, similar to that observed in cholera stool. A large rectal villous adenoma was discovered on sigmoidoscopy, and definitive management was achieved by removal of the tumor. This case provides a demonstration of the ranging metabolic disturbance associated with secretory diarrhea. Other endogenous and infective causes are discussed, and mechanisms compared with the case described.
Winstanley
Virginia
V
Department of Endocrinology, Imperial College Healthcare NHS Trust, and Imperial College Faculty of Medicine, London, UK.
Little
Mark A
MA
Wadsworth
Christopher
C
Cohen
Patrizia
P
Martin
Niamh M
NM
D058186:Acute Kidney Injury / Q000209:etiology* / Q000503:physiopathology; D018253:Adenoma, Villous / Q000150:complications / Q000473:pathology* / Q000601:surgery; D001707:Biopsy, Needle; D002771:Cholera / Q000150:complications*; D003082:Colectomy / Q000379:methods; D003113:Colonoscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D035583:Rare Diseases; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D013577:Syndrome; D016896:Treatment Outcome; D014883:Water-Electrolyte Imbalance / Q000150:complications / Q000175:diagnosis* / Q000628:therapy