title: Severe metabolic alkalosis and recurrent acute on chronic kidney injury in a patient with Crohn's disease.
abstract: BACKGROUND
  Diarrhea is common in patients with Crohn's disease and may be accompanied by acid base disorders, most commonly metabolic acidosis due to intestinal loss of bicarbonate.
  
  
  METHODS
  Here, we present a case of severe metabolic alkalosis in a young patient suffering from M. Crohn. The patient had undergone multiple resections of the intestine and suffered from chronic kidney disease. He was now referred to our clinic for recurrent acute kidney injury, the nature of which was pre-renal due to profound volume depletion. Renal failure was associated with marked hypochloremic metabolic alkalosis which only responded to high volume repletion and high dose blockade of gastric hypersecretion. Intestinal failure with stomal fluid losses of up to 5.7 litres per day required port implantation to commence parenteral nutrition. Fluid and electrolyte replacement rapidly improved renal function and acid base homeostasis.
  
  
  CONCLUSIONS
  This case highlights the important role of gastrointestinal function to maintain acid base status in patients with Crohn's disease.
authors.affiliation: Department of Nephrology and Hypertension, University Erlangen-Nuremberg, Erlangen, Germany. johannes.jacobi@uk-erlangen.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Jacobi
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnellhardt
authors.forename: Mirian
authors.initials: M
authors.lastname: Opgenoorth
authors.forename: Kerstin U
authors.initials: KU
authors.lastname: Amann
authors.forename: Axel
authors.initials: A
authors.lastname: Küttner
authors.forename: Axel
authors.initials: A
authors.lastname: Schmid
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Eckardt
authors.forename: Karl F
authors.initials: KF
authors.lastname: Hilgers
mesh_terms: D000169:Acrodermatitis / Q000209:etiology / Q000473:pathology; D000208:Acute Disease; D000328:Adult; D000471:Alkalosis / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D003424:Crohn Disease / Q000601:surgery*; D003677:Deficiency Diseases / Q000150:complications; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005772:Gastrointestinal Transit; D006801:Humans; D008046:Lip; D008297:Male; D009666:Nose; D010288:Parenteral Nutrition; D012008:Recurrence; D051437:Renal Insufficiency / Q000209:etiology* / Q000628:therapy; D012720:Severity of Illness Index; D015032:Zinc / Q000172:deficiency
chemical_list: D015032:Zinc
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