Acquired pyloric stenosis resulting in hypokalaemic, hyperchloraemic normal anion gap metabolic acidosis. Persistent vomiting in an adult: cause and effect. (17th January 2018)

• Record Type: Journal Article
• Authors: Kaye, Philip
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-01-17
• Subjects: arrhythmias -- metabolic disorders -- stomach and duodenum; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2017-222800
• Languages: English
• ISSNs: 1757-790X

Abstract

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.