Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge
Joint Authors
Ijaz, Mohsin
Lvovsky, Dmitry
Abbas, Naeem
Source
Issue
Vol. 2015, Issue 2015 (31 Dec. 2015), pp.1-5, 5 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2015-06-08
Country of Publication
Egypt
No. of Pages
5
Main Subjects
Abstract EN
Metabolic alkalosis secondary to citrate toxicity from plasma exchange is very uncommon in patients with normal renal function.
In patients with advanced renal disease this can be a fatal event.
We describe a case of middle-aged woman with Goodpasture’s syndrome treated with plasma exchange who developed severe metabolic alkalosis.
High citrate load in plasma exchange fluid is the underlying etiology.
Citrate metabolism generates bicarbonate and once its level exceeds the excretory capacity of kidneys, the severe metabolic alkalosis ensues.
Our patient presented with generalized weakness, fever, and oliguria and developed rapidly progressive renal failure.
Patient had positive serology for antineutrophilic cytoplasmic antibodies myeloperoxidase (ANCA-MPO) and anti-glomerular basement membrane antibodies (anti-GBM).
Renal biopsy showed diffuse necrotizing and crescentic glomerulonephritis with linear glomerular basement membrane staining.
Patient did not respond to intravenous steroids.
Plasma exchange was started with fresh frozen plasma but patient developed severe metabolic alkalosis.
This metabolic alkalosis normalized with cessation of plasma exchange and initiation of low bicarbonate hemodialysis.
ANCA-MPO and anti-GBM antibodies levels normalized within 2 weeks and remained undetectable at 3 months.
Patient still required maintenance hemodialysis.
American Psychological Association (APA)
Ijaz, Mohsin& Abbas, Naeem& Lvovsky, Dmitry. 2015. Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge. Case Reports in Critical Care،Vol. 2015, no. 2015, pp.1-5.
https://search.emarefa.net/detail/BIM-1058216
Modern Language Association (MLA)
Ijaz, Mohsin…[et al.]. Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge. Case Reports in Critical Care No. 2015 (2015), pp.1-5.
https://search.emarefa.net/detail/BIM-1058216
American Medical Association (AMA)
Ijaz, Mohsin& Abbas, Naeem& Lvovsky, Dmitry. Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge. Case Reports in Critical Care. 2015. Vol. 2015, no. 2015, pp.1-5.
https://search.emarefa.net/detail/BIM-1058216
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1058216