title: Non-anion gap metabolic acidosis in a patient with a pancreaticopleural fistula.
abstract: While acid-base disturbances are known to occur with chronic pancreatitis, few cases have been reported in which non-anion gap metabolic acidosis is caused by pancreaticopleural fistula, a known complication of chronic pancreatitis. The current report describes the case of a 49-year-old African American woman who presented with severe pleuritic chest pain and dyspnea at rest. The patient had a history of alcohol-induced chronic pancreatitis. Her chest radiograph was positive for a large left-sided pleural effusion. Magnetic resonance cholangiopancreatography revealed a small connection between the pancreas and the thoracic cavity. Arterial blood gas analysis revealed non-anion gap metabolic acidosis in the absence of substantial urinary or diarrheal bicarbonate losses. The patient was diagnosed as having non-anion gap metabolic acidosis as a result of a pancreaticopleural fistula and was successfully treated with pancreatic ductal stent placement by means of endoscopic retrograde cholangiopancreatography.
authors.affiliation: OMS IV, Downers Grove, IL 60615-1235, USA. eovaldi@gmail.com
authors.forename: Benjamin
authors.initials: B
authors.lastname: Eovaldi
authors.forename: Claude
authors.initials: C
authors.lastname: Zanetti
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000473:pathology*; D002637:Chest Pain / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D049448:Cholangiopancreatography, Magnetic Resonance; D004417:Dyspnea; D005260:Female; D006801:Humans; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D019512:Pancreatitis, Alcoholic; D010995:Pleural Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology