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Retrograde Colonic Irrigations in a Newborn Resulted in Extreme Hyperchloremia and Metabolic Acidosis

Zwol Annelies

Hyperchloremic acidosis is a metabolic acid-base disorder characterized by a decrease in serum bicarbonate levels and an increase in chloride concentration. It can result from various underlying conditions, including renal dysfunction, gastrointestinal losses, respiratory alkalosis, and certain medications. This acid-base disturbance disrupts the body’s pH balance and can have significant clinical implications.

The pathophysiology of hyperchloremic acidosis involves an imbalance between the production and excretion of acids, leading to an accumulation of chloride ions and a decrease in bicarbonate levels. This disrupts the normal acidbase buffering mechanisms, resulting in acidemia and potential complications such as electrolyte imbalances, impaired cellular function, and altered organ system performance.

Diagnosis of hyperchloremic acidosis is based on arterial blood gas analysis, serum electrolyte levels, and assessment of the underlying cause. Treatment strategies focus on addressing the underlying condition and correcting the acid-base imbalance. This may involve fluid and electrolyte replacement, correcting the primary cause, and sometimes administration of bicarbonate to restore bicarbonate levels.

While hyperchloremic acidosis is often seen as a compensatory response to other underlying disorders, it can also contribute to the progression of certain conditions and affect patient outcomes. Therefore, timely recognition, appropriate management, and addressing the underlying cause are essential for optimizing patient care.

In conclusion, hyperchloremic acidosis is a metabolic acid-base disorder characterized by a decrease in bicarbonate levels and an increase in chloride concentration. Understanding the pathophysiology, diagnosing the condition  accurately, and implementing appropriate treatment strategies are crucial for managing patients with hyperchloremic acidosis and improving their clinical outcomes.