Acquired pyloric stenosis resulting in hypokalaemic, hyperchloraemic normal anion gap metabolic acidosis. Persistent vomiting in an adult: cause and effect.

Abstract

A 24-year-old woman presented with a history of persistent vomiting for at least 3 months. This resulted in severe dehydration with risk of acute kidney injury. In addition to volume depletion, loss of gastric fluid resulted in a specific metabolic derangement-hypokalaemic, hypochloraemic normal anion gap metabolic alkalosis with a reduced ionised calcium concentration and paradoxical aciduria. These metabolic changes were reflected in her ECG. Investigation demonstrated acquired gastric outflow tract obstruction secondary to a pyloric peptic ulcer. The patient was resuscitated with intravenous crystalloid and electrolyte supplements. The acquired pyloric stenosis was treated medically with a proton pump inhibitor and Helicobacter pylori eradication therapy with excellent recovery.

• Authors: Philip Kaye
• Journal: BMJ case reports (BMJ Case Rep) Vol. 2018 (Jan 17 2018) ISSN: 1757-790X [Electronic] England
• PMID: 29348282 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Topics

• Acid-Base Equilibrium
• Acidosis (etiology)
• Dehydration (etiology)
• Female
• Humans
• Hypokalemia (etiology)
• Peptic Ulcer (complications)
• Pyloric Stenosis (complications)
• Vomiting (etiology)
• Young Adult