title: [Intraperitoneal irrigation for pseudomyxoma peritonei-a case of critical metabolic alkalosis precipitated by irrigation with 101 of sodium bicarbonate--].
abstract: Pseudomyxoma peritonei causes marked accumulation of jelly-like ascites in the peritoneal cavity. Removal of much mucinous ascites by irrigating the cavity appears to be an effective treatment. We describe a patient who underwent the irrigation with sodium bicarbonate solution and developed critical alkalemia. A 68-year-old woman with normal renal function was operated on for recurrent pseudomyxoma peritonei. Fol- lowing the excision of primary lesion, her intraperitoneal cavity was irrigated with 10 1 of 7% sodium bicarbonate in about 45 minutes. Thirty minutes after irrigation, blood gas analysis revealed severe metabolic alkalosis (pH 7.714, BE 25.6 mmol x l-1 ) with electrolyte disorder (Na 157.8 mmol x l-1 K 2.31mmol x l-1, Ca 0.73 mmol x l-1). Hypotension (<60 mmHg) and sinus tachycardia (>130 beats x min -1) supervened 75 minutes later. Transferring to the ICU, she was given KC1 solution intravenously based on serial blood analysis while on mechanical ventilation. The next day acid-base disturbance returned spontaneously to normal (pH 7.45, BE 8.0mmol x l-1), leading to endotracheal extubation. Electrolyte imbalance was gradually resolved on 2nd POD and she was discharged from the ICU. Intraperitoneal irrigation with sodium bicarbonate requires special perioperative considerations for lifethreatening alkalemia, especially in a patient with renal impairment.
authors.affiliation: Department of Anesthesiology and Intensive Care, Chubu Rosai Hospital, Nagoya 455-8530.
authors.forename: Reimi
authors.initials: R
authors.lastname: Shirasaki
authors.forename: Saeko
authors.initials: S
authors.lastname: Yamasaki
authors.forename: Masaki
authors.initials: M
authors.lastname: Wakamatsu
authors.forename: Yasuichiro
authors.initials: Y
authors.lastname: Mori
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hirano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaida
authors.forename: Asami
authors.initials: A
authors.lastname: Machino
mesh_terms: D000137:Acid-Base Imbalance / Q000139:chemically induced; D000368:Aged; D000471:Alkalosis / Q000139:chemically induced*; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D010533:Peritoneal Lavage / Q000009:adverse effects*; D010534:Peritoneal Neoplasms / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000628:therapy*; D012008:Recurrence; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000008:administration & dosage* / Q000009:adverse effects*; D013514:Surgical Procedures, Operative
chemical_list: D017693:Sodium Bicarbonate