An unexpected cause of severe metabolic acidosis
Introduction: Metabolic acidosis is a potentially serious electrolyte disorder with a variety of potential causes. It can cause serious harm to multiple organ systems with irreversible damage and if untreated it can even cause mortality. Case description: A 66-year-old man presented at the emergency...
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SMC MEDIA SRL
2025-05-01
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| Series: | European Journal of Case Reports in Internal Medicine |
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| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/5276 |
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| author | Suzanne K. Veneman Stephanie E. Veneman Hardjit Kharagjitsing Thiemo F. Veneman |
| author_facet | Suzanne K. Veneman Stephanie E. Veneman Hardjit Kharagjitsing Thiemo F. Veneman |
| author_sort | Suzanne K. Veneman |
| collection | DOAJ |
| description | Introduction: Metabolic acidosis is a potentially serious electrolyte disorder with a variety of potential causes. It can cause serious harm to multiple organ systems with irreversible damage and if untreated it can even cause mortality.
Case description: A 66-year-old man presented at the emergency room of our hospital because of abdominal pain, nausea, and vomiting for 3 days, with no diarrhoea. Physical examination showed a sick, restless, shaking, middle-aged man with a maximal eye-motor-verbal score. He had a history of polycythaemia vera but had been lost to follow-up. He was clinically dehydrated with extremely dry mucous membranes and complaining of thirst. Laboratory investigations showed severe metabolic acidosis with a pH of 7.08 and electrolyte disturbances with hyperkalaemia and hyponatremia. The treatment with a high dose of hydroxyurea had been re-started 14 days before presentation at the emergency room.
Conclusion: We believe that the recent initiation of the treatment with a (too) high dose of hydroxyurea with consequently gastrointestinal complications could have been the underlying cause. In addition to the indirect effect of dehydration resulting from the gastrointestinal side effects of hydroxyurea, another known but rarely reported adverse effect is (tubular) renal dysfunction, which may have contributed to the progression of metabolic acidosis. The exact mechanisms by which hydroxyurea induces metabolic acidosis remain unknown. It is important to recognize hydroxyurea as the culprit of the development of severe metabolic acidosis. If unrecognized, metabolic acidosis can worsen and cause irreversible damage. |
| format | Article |
| id | doaj-art-a19486e129e64dbe93b8fcea0938cc07 |
| institution | OA Journals |
| issn | 2284-2594 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj-art-a19486e129e64dbe93b8fcea0938cc072025-08-20T02:05:20ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942025-05-0110.12890/2025_0052764811An unexpected cause of severe metabolic acidosisSuzanne K. Veneman0Stephanie E. Veneman1Hardjit Kharagjitsing2Thiemo F. Veneman3Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDepartment of Intensive Care, Amsterdam University Medical Center, Amsterdam, The NetherlandsDepartment of Nephrology, Horacio Oduber Hospital, Oranjestad, ArubaDepartment of Intensive Care Medicine, Horacio Oduber Hospital, Oranjestad, ArubaIntroduction: Metabolic acidosis is a potentially serious electrolyte disorder with a variety of potential causes. It can cause serious harm to multiple organ systems with irreversible damage and if untreated it can even cause mortality. Case description: A 66-year-old man presented at the emergency room of our hospital because of abdominal pain, nausea, and vomiting for 3 days, with no diarrhoea. Physical examination showed a sick, restless, shaking, middle-aged man with a maximal eye-motor-verbal score. He had a history of polycythaemia vera but had been lost to follow-up. He was clinically dehydrated with extremely dry mucous membranes and complaining of thirst. Laboratory investigations showed severe metabolic acidosis with a pH of 7.08 and electrolyte disturbances with hyperkalaemia and hyponatremia. The treatment with a high dose of hydroxyurea had been re-started 14 days before presentation at the emergency room. Conclusion: We believe that the recent initiation of the treatment with a (too) high dose of hydroxyurea with consequently gastrointestinal complications could have been the underlying cause. In addition to the indirect effect of dehydration resulting from the gastrointestinal side effects of hydroxyurea, another known but rarely reported adverse effect is (tubular) renal dysfunction, which may have contributed to the progression of metabolic acidosis. The exact mechanisms by which hydroxyurea induces metabolic acidosis remain unknown. It is important to recognize hydroxyurea as the culprit of the development of severe metabolic acidosis. If unrecognized, metabolic acidosis can worsen and cause irreversible damage.https://www.ejcrim.com/index.php/EJCRIM/article/view/5276metabolic acidosishydroxyureaanion gap |
| spellingShingle | Suzanne K. Veneman Stephanie E. Veneman Hardjit Kharagjitsing Thiemo F. Veneman An unexpected cause of severe metabolic acidosis European Journal of Case Reports in Internal Medicine metabolic acidosis hydroxyurea anion gap |
| title | An unexpected cause of severe metabolic acidosis |
| title_full | An unexpected cause of severe metabolic acidosis |
| title_fullStr | An unexpected cause of severe metabolic acidosis |
| title_full_unstemmed | An unexpected cause of severe metabolic acidosis |
| title_short | An unexpected cause of severe metabolic acidosis |
| title_sort | unexpected cause of severe metabolic acidosis |
| topic | metabolic acidosis hydroxyurea anion gap |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/5276 |
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