A case of severe metabolic alkalosis caused by an enteral feeding product in a dialysis patient

Abstract

Key words：enteral feeding product, hemodialysis, alkalosis, alkalemia, hyperkalemia 〈Abstract〉 In July 2007, a 72-year-old man with a 4-year history of renal insufficiency started hemodialysis due to postinfectious glomerulonephritis. The patient underwent surgery for rupture of chronic aortic dissection in early August and hemodialysis was continued. Due to prolonged postoperative consciousness disturbance, enteral feeding was started and PEG was inserted in late November. To prevent repeated aspiration, the enteral products were changed from Renalen®and Q. P K-4S®to Medief®Pushcare, a gel-type formula. However, the patient ／ ／ subsequently developed severe metabolic alkalosis and hyperkalemia(pH 7.60, HCO3 − 36.8 mEq／L, K 6.5 mEq／ L). Discontinuation of this product and feeding with Terumeal®PG soft rapidly improved both metabolic alkalosis and hyperkalemia. We speculated that the higher concentration of sodium compared to chloride in Medief®