Abstract: SA-PO519
A Case of Metabolic Alkalosis, Hyponatremia, and Hypokalemia Secondary to Dietary Chloride Deficiency Syndrome in a J Tube-Dependent Patient
Session Information
- Acid-Base, Calcium, Potassium, and Magnesium Disorders: Clinical
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Kapyur, Amitha N., Los Angeles General Medical Center, Los Angeles, California, United States
- Ong, John C., Los Angeles General Medical Center, Los Angeles, California, United States
- Shah, Sapna, Keck Hospital of USC, Los Angeles, California, United States
Introduction
Chloride deficiency is a well-established contributor of metabolic alkalosis. Hypochloremia results predominantly from renal and extra-renal losses, and rarely from decreased intake. Here, we report a case of metabolic alkalosis, hyponatremia, and hypokalemia from insufficient chloride content in enteral formula in a J-tube dependent patient.
Case Description
A 36 year-old-male with past medical history of caustic injury secondary to alkali ingestion with laryngeal, esophageal, and pyloric strictures who is J-tube dependent for nutrition presents for routine J tube exchange, and is admitted for electrolyte abnormalities. He is otherwise in normal health without any gastrointestinal symptoms or abnormal gastrostomy output. Laboratory tests were notable for pH7.64, PaCO2 53 mm Hg, bicarbonate >50 mEq/L, Na 130 mEq/L, K 2.6 mEq/L, Cl 65 mEq/L, BUN 119 mEq/L and Cr 2.67 mEq/L. XR demonstrated appropriate positioning of his GJ tube. His outpatient enteral nutrition prescription was 5 cartons of TwoCal formula daily. The nutritional chloride content of this prescription is 1.1g/day which is significantly below the daily recommended intake
Discussion
Metabolic alkalosis is one of the most common acid-base disturbances encountered in the hospital setting and is associated with an increased mortality. In a population where nutrition is entirely dependent on an artificial formulation, insufficient electrolyte additions can lead to severe complications. TThere are hundreds of formulations available for enteral feeding, with each varying in their composition. Per USDA, the recommended amount of intake of chloride in an adult is thought to be about 2.3 - 3.1g, though no standardized number has been established. Electrolytes such as sodium and potassium often receive a lot of focus due to their role in metabolic homeostasis while chloride is often overlooked. We suggest that clinicians should include chloride content in their decision making when choosing enteral artificial nutrition in order to avoid an under-recognized potential complication of metabolic alkalosis, hyponatremia, and hypokalemia due to chloride deficiency syndrome.