Survival after severe metabolic acidosis (pH=6.66)

Backround: Metabolic acidosis is an acid-base disturbance, which is characterized by primary consumption of body buffers and causing decreased blood HCO3- level. In this article we discus a case with severe metabolic acidosis (pH=6.66) due to diarrhea that was caused by chemotherapeutic agents.
Case: The patient was a male aged 20 and had colon cancer with bone metastase. He started getting chemotherapy three months ago. When he was seen in the emergency service he was unconscious and had convulsion. He had diarrhea in his history. He was intubated and put on the mechanical ventilator after admittance to the ICU. Arteriel blood gas values were pH: 6.66, PaCO2: 102 mmHg, PaO2: 307 mmHg, HCO3: 10.7 mmol L-1, SpO2: %97, BE: -23 mmol L-1 and laktat: 28 mmol L-1. Convulsion were stopped after giving benzodiazepine and barbiturate respectively. Fluid and NaHCO3 replacement were provided. After ten hours arteriel blood gas values were measured as normal and he was extubated. He was transferred to an oncology clinic after observation for 3 days.
Result: It should be considered that risk of severe metabolic acidosis and planing early and suitable therapy when developed diarrhea in patients who are used chemotherapy.

Ciddi metabolik asidoz sonrasý saðkalým: (pH=6.66)

Giriþ: Metabolik asidoz, kanda bikarbonat konsantrasyonunda azalmaya neden olan, vücut tamponlarýnýn birincil tüketimi ile karakterize bir asit-baz bozukluðudur. Bu olguda kemoterapötik kullanýmýna baðlý diyare nedeni ile yaþamla baðdaþmayan derin metabolik asidoz (pH=6.66) geliþen olguyu sunmayý amaçladýk.
Olgu: Kolon kanseri ve kemik metastazý tanýsýyla 3 ay önce kemoterapi baþlanmýþ olan 20 yaþýndaki erkek hasta ani bilinç kaybý, konvülsiyon ve diyare nedeniyle acil servise baþvurduðunda tarafýmýzdan deðerlendirildi. Entübe edilerek reanimasyon ünitesine alýnan hastanýn burada alýnan arteriyel kan örneðinde pH: 6.66, PaCO2: 102 mmHg, PaO2: 307 mmHg, HCO3: 10,7 mmol L-1, SpO2: %97, BE: -23 mmol L-1, laktat: 28 mmol L-1 olarak saptandý. Mekanik ventilatöre baðlanan hastanýn konvülsiyonlarý sýrasý ile benzodiazepin ve barbitürat kullanýlarak durduruldu. Hastaya sývý ve sodyum bikarbonat replasmaný yapýldý. Arteriyel kan gazý deðerleri 10 saat sonra normal olarak saptanan hasta ekstübe edildi. Yoðun bakým ünitesinde 3 gün takip edildikten sonra dýþ merkezde onkoloji kliniðine transfer edildi.
Sonuç: Malignensi tanýsý olan ve kemoterapi uygulanan hastalarda diyare geliþmesi durumunda derin metabolik asidoz geliþebileceði göz önünde tutulmalý, erken ve uygun tedavi planlanmalýdýr.