Acute Hypocalcemia and Metabolic
Alkalosis in Children on Cation-Exchange Resin Therapy.
Of note, only one patient had a pre-dialysis serum tC[O.sub.2] level slightly higher than 26 mEq/L, allowing us to conclude that none of our patients had unsafe levels of metabolic
alkalosis pointed out in previous studies (8,9,18,19).
Laboratory investigations showed hypokalaemia (2.5 Meq/L), shypochloraemia (64 Meq/L) and metabolic
alkalosis. Since there was history of unexplained polyhydramnios along with hypokalaemia, hypochloraemia and metabolic
alkalosis,neonatal Bartter syndrome was suspected.
Other genetic syndromes, such as Bartter's or Gitelman's, cause hypokalaemia with
alkalosis but without hypertension.
A recent study from our research group has demonstrated that a 14-d supranutritional antioxidant supplementation (100 IU/kg VE plus 1.2 ppm selenium) could not only mitigate oxidative stress, but also effectively ameliorate the respiration rate and respiratory
alkalosis in heat-stressed sheep [13], suggesting that a short-term supranutritional antioxidant supplementation effectively mitigate the HS-induced oxidative stress and exhibit a novel function in maintaining acid-base balance.
For practical purposes, all acid-base disturbances are referred to as "acidosis or
alkalosis", without making any distinction with regard to the terms "acidemia and alkalemia".
Lab-analysis showed the following: normal renal, hepatic, and thyroid function; normal coagulation tests; normal white cell and platelet count; mild normocytic anemia (Hb = 10 g/dl); metabolic
alkalosis associated with severe hypokalemia.
Metabolic
alkalosis was noted to be chloride resistant (urine chloride of >20mEq/dl).
[7] reported a series of eight patients with atypical genetically determined Bartter syndrome type 1, including absence of nephrocalcinosis, absence of hypokalemia, and/or metabolic
alkalosis in the first year of life as well as persistent metabolic acidosis mimicking distal renal tubular acidosis.
Normal calcium, phosphorous, and magnesium levels were found, while there were high creatine phosphokinase levels (1029 U/L) and metabolic
alkalosis. Thyroid function tests were in normal limits.
ABG (arterial blood gas) revealed raised lactate (2.3 mmol/L), respiratory
alkalosis and hypoxia.
Animals with mechanical obstruction are at risk for hypokalemia, hyponatremia, hypochloremia, metabolic acidosis and metabolic
alkalosis (Mishra et al., 1974).
