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 eradication therapy with excellent recovery.

Recovery from severe metabolic alkalosis with acute kidney injury due to gastric cancer: a case report

“…Pyloric stenosis or GOO, the major cause of metabolic alkalosis is often treated using surgical or endoscopic procedures 3,4) . Although most published cases related to metabolic alkalosis and acute kidney injury were caused by pyloric ulcers, the incidence of peptic ulcer-related disease has decreased steadily worldwide 5,6) . Table 2 revealed few reports related to gastric cancer-induced GOO resulting in metabolic alkalosis and acute kidney injury 7) .…”

Acute Kidney Injury with Severe Metabolic Alkalosis Caused by Habitual Vomiting in an Alcohol Abuser with Pyloric Stenosis

“…In general, urine excretion of H + is restricted in patients with metabolic alkalosis. However, in patients with advanced volume depletion, the preservation of Na + is prioritized over H + , which is then secreted into the urine ( 6 , 7 ).…”

Gastric Outlet Obstruction Secondary to Pyloric Thickening in an Adolescent Male

“…When the obstruction becomes chronic, the continuous vomiting can cause dehydration, electrolyte imbalance, and malnutrition. 16 Initially, the patient may demonstrate better tolerance to liquids rather than solid food. In the later stages, due to the inability to retain food and liquid, the patient may exhibit severe weight loss and clinical signs of malnutrition.…”