Severe metabolic acidosis and hypokalemia in a patient with enterovesical fistula

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• 作者：Kazutaka Murakami ; Makoto Tomita ; Nahoko Kawamura ; Midori Hasegawa ; Kunihiro Nabeshima ; Yoshiyuki Hiki and Satoshi Sugiyama
• 关键词：Metabolic acidosis ; Hypokalemia ; Enterovesical fistula
• 刊名：Clinical and Experimental Nephrology
• 出版年：2007
• 出版时间：September, 2007
• 年：2007
• 卷：11
• 期：3
• 页码：225-229
• 全文大小：320 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Nephrology
  Internal Medicine
  Urology and Andrology
  
• 出版者：Springer Japan
• ISSN：1437-7799

文摘

We report a case of a 59-year-old woman who had severe metabolic acidosis and hypokalemia due to an enterovesical fistula. The patient came to our hospital complaining of systemic weakness and numbness of the fingers. She was found to have hyperchloremic metabolic acidosis (arterial bicarbonate, 2.8 mEq/l) and hypokalemia (serum potassium, 1.9 mEq/l) and was admitted for treatment. Following the correction of metabolic acidosis and hypokalemia, the patient was examined for the underlying cause of these electrolyte and acid-base disorders. She had a history of total hysterectomy followed by radiotherapy due to uterine cancer 30 years previously. After the surgery, she had suffered postoperative neurogenic bladder dysfunction, necessitating intermittent self-catheterization. Two years before admission, she had begun to experience watery diarrhea. A radiographic study after recovery from the acid-base and electrolyte disorders revealed the presence of an enterovesical fistula. The fistula was surgically resected and the metabolic acidosis completely cleared. Unexplained hyperchloremic metabolic acidosis with hypokalemia may suggest the presence of an enterovesical fistula in patients with a surgical history of malignant pelvic tumor and neurogenic bladder dysfunction.