pica and Alkalosis

Severe metabolic alkalosis is rarely seen in end stage renal disease (ESRD) patients on long-term hemodialysis. This can be life threatening and mortality is exponentially increased when the pH exceeds 7.60. Persistent vomiting, ingestion of alkali for dyspepsia and pica behavior are all potential causes of such severe metabolic alkalosis. The prevalence of pica is increased in chronic kidney disease and ESRD patients, with ice being the most commonly ingested substance. It can cause a myriad of complications including death, but the diagnosis may be elusive unless the pica behavior is witnessed firsthand by others since patients do not typically disclose their behavior. We present the case of a hemodialysis patient with severe alkalemia, hypernatremia, and excessive interdialytic weight gains resulting in recurrent hospitalizations for fluid overload due to baking soda pica behavior.

Topics: Alkalosis; Humans; Kidney Failure, Chronic; Pica; Renal Dialysis; Sodium Bicarbonate

We report a case of baking soda pica in a woman at 31 weeks of pregnancy causing severe hypokalemic metabolic alkalosis and rhabdomyolysis.. A multigravida at 31 weeks of gestation presented with weakness and muscle pain. She was found to have severe hypokalemic metabolic alkalosis and rhabdomyolysis, with elevation in serum transaminases and hypertension. We initially thought the patient had an atypical presentation of preeclampsia until it was realized that she was ingesting 1 full box of baking soda (454 g sodium bicarbonate) per day. Symptoms and abnormal laboratory findings resolved with discontinuation of the patient's pica practices.. Pica is a common but often overlooked practice that can potentially lead to life-threatening disorders. A thorough evaluation of a patient's dietary intake is extremely important, especially in the setting of atypical presentations of disease in pregnancy.

Topics: Adult; Alkalosis; Female; Humans; Hypokalemia; Pica; Pregnancy; Pregnancy Complications; Rhabdomyolysis; Sodium Bicarbonate

Topics: Adult; Alkalosis; Aspirin; Citrates; Drug Combinations; Female; Humans; Iron Deficiencies; Kidney Failure, Chronic; Pica; Renal Dialysis; Seizures; Sodium Bicarbonate

Topics: Alkalosis; Female; Humans; Kidney Failure, Chronic; Middle Aged; Pica; Renal Dialysis; Sodium Bicarbonate