Severe metabolic alkalosis–a diagnostic dilemma

Nathalie Foray, DO, MS; Taylor Stone, MD; Alexander Johnson, MD; Mirza Ali, MD; Shreedhar Kulkarni, MD; John Gao, MD/PhD; Rajagopal Sreedhar, MD

Respiratory Medicine Case Reports (Jan 2018)

Severe metabolic alkalosis–a diagnostic dilemma

Nathalie Foray, DO, MS,
Taylor Stone, MD,
Alexander Johnson, MD,
Mirza Ali, MD,
Shreedhar Kulkarni, MD,
John Gao, MD/PhD,
Rajagopal Sreedhar, MD

Affiliations

Nathalie Foray, DO, MS: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, PO Box 19636, Springfield, IL, 62794, USA; Corresponding author.
Taylor Stone, MD: Department of Internal Medicine, Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL, 62702, USA
Alexander Johnson, MD: Department of Internal Medicine, Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL, 62702, USA
Mirza Ali, MD: Department of Internal Medicine, Southern Illinois University School of Medicine, 801 N Rutledge St, Springfield, IL, 62702, USA
Shreedhar Kulkarni, MD: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, PO Box 19636, Springfield, IL, 62794, USA
John Gao, MD/PhD: Department of Pathology, Memorial Medical Center, 701 North 1st Street, Springfield, IL 62781, USA
Rajagopal Sreedhar, MD: Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Southern Illinois University School of Medicine, PO Box 19636, Springfield, IL, 62794, USA

Journal volume & issue: Vol. 25
pp. 177 – 180

Abstract

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Background: Cushing's syndrome due to ectopic ACTH secretion has been associated with many cancers; most commonly small cell carcinoma of the lung and bronchial carcinoid tumors. Usually, patients who confer this diagnosis have poor prognosis. Case presentation: A 66-year-old female presented with worsening shortness of breath and weakness over three days. Initial laboratory derangements included severe hypokalemia and metabolic alkalosis. Treatment included high amounts of potassium chloride and acetazolamide. Imaging studies revealed anterior medial right upper lobe lung mass as well as suspicion for many liver metastases. Liver biopsy was sought and was positive for small cell carcinoma. Conclusion: We describe a case of severe metabolic alkalosis and hypokalemia in a patient with Cushing's syndrome due to ectopic ACTH secretion from small cell lung cancer. To our knowledge, this is the first case identified which exhibited such significant metabolic derangements in the form of serum and arterial blood bicarbonate. As prognosis is quite poor, we recommend swift diagnosis and management.

Published in Respiratory Medicine Case Reports

ISSN: 2213-0071 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: http://www.journals.elsevier.com/respiratory-medicine-case-reports/

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