Severe metabolic alkalosis and recurrent acute on chronic kidney injury in a patient with Crohn's disease.
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.
Jacobi
Johannes
J
Department of Nephrology and Hypertension, University Erlangen-Nuremberg, Erlangen, Germany. johannes.jacobi@uk-erlangen.de
Schnellhardt
Susanne
S
Opgenoorth
Mirian
M
Amann
Kerstin U
KU
Küttner
Axel
A
Schmid
Axel
A
Eckardt
Kai-Uwe
KU
Hilgers
Karl F
KF
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
D015032:Zinc
Am J Kidney Dis. 2003 Dec;42(6):1283-6
14655202
Hum Mutat. 2002 Dec;20(6):425-38
12442266
Best Pract Res Clin Gastroenterol. 2003 Dec;17(6):895-906
14642856
Proc Natl Acad Sci U S A. 2004 Feb 24;101(8):2636-41
14983061
Jpn J Surg. 1989 Sep;19(5):519-23
2593388
J Physiol. 2009 May 15;587(Pt 10):2179-85
19015189
Gastroenterology. 2001 Mar;120(4):806-15
11231933
Ann Surg. 1995 Sep;222(3):243-54; discussion 254-5
7677455
Gut. 1998 Dec;43(6):763-9
9824602
Kidney Int. 1975 Nov;8(5):279-83
536
Am J Kidney Dis. 2008 Sep;52(3):494-500
18562060
Dtsch Med Wochenschr. 2007 Aug;132(34-35):1763-7
17713886
Transplant Proc. 1990 Dec;22(6):2427-9
2124738
Transpl Int. 2008 May;21(5):401-14
18282247
Pflugers Arch. 2009 May;458(1):137-56
19277700
Am J Physiol. 1998 Dec;275(6):G1445-53
9843783
N Engl J Med. 1998 Aug 13;339(7):451-8
9700180
J Am Soc Nephrol. 2000 Feb;11(2):369-375
10665945
Am J Gastroenterol. 2004 Jul;99(7):1386-95
15233682