Ileal Neobladder: An Important Cause of Non-Anion Gap Metabolic Acidosis.
BACKGROUND
The differential diagnosis for a non-anion gap metabolic acidosis is probably less well known than the differential diagnosis for an anion gap metabolic acidosis. One etiology of a non-anion gap acidosis is the consequence of ileal neobladder urinary diversion for the treatment of bladder cancer.


METHODS
We present a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a urinary tract infection and ureteroenterostomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Part of the ileal neobladder surgery includes ureteroenterostomy and predisposes patients to several clinically significant metabolic derangements, including a non-anion gap metabolic acidosis. These patients have an increased chronic acid load, bicarbonate deficit, and hypokalemia, which should be appreciated when resuscitating these patients.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Jesse W
JW
St Clair
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts.
Matthew L
ML
Wong
D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000175:diagnosis* / Q000209:etiology; D023341:Chills / Q000209:etiology; D003937:Diagnosis, Differential; D005334:Fever / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D014519:Ureterostomy / Q000009:adverse effects; D016482:Urinalysis; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000628:therapy*; D014547:Urinary Diversion / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000150:complications*
ileal conduit; neobladder; non-anion gap metabolic acidosis; urology