Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report
Retrograde colonic irrigation (RCI) using normal saline (NS) is a widely used method to treat constipation, or to prepare the bowels for colorectal surgeries in children. Using large amounts of NS during RCI could induce electrolyte disturbances. A case of extreme hyperchloremic metabolic acidosis f...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Journal of Pediatric Surgery Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213576623000647 |
| _version_ | 1797829537735639040 |
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| author | Ruben Visch Annelies van Zwol Herjan van der Steeg Joris Fuijkschot Anneliese Nusmeier |
| author_facet | Ruben Visch Annelies van Zwol Herjan van der Steeg Joris Fuijkschot Anneliese Nusmeier |
| author_sort | Ruben Visch |
| collection | DOAJ |
| description | Retrograde colonic irrigation (RCI) using normal saline (NS) is a widely used method to treat constipation, or to prepare the bowels for colorectal surgeries in children. Using large amounts of NS during RCI could induce electrolyte disturbances. A case of extreme hyperchloremic metabolic acidosis following RCI with large volumes of NS in a neonate with Hirschsprung disease has not been described to date.We report a 24 days old patient with Trisomy 21 and Hirschsprung disease, that received RCI twice a day in a NS rectal bolus from day 10 of age, presenting with respiratory and circulatory insufficiency. Lab results showed extreme hyperchloremic acidosis, which was attributed to gastro-intestinal fluid resorption of large volumes of NS. The patient showed clinical improvement after supplementation of sodium bicarbonate and made an uneventful full recovery.This case report emphasizes the need to carefully monitor children for electrolyte disturbances, fluid balance, bodyweight and returned irrigation volumes when RCI is used with large volumes of NS for multiple days. |
| first_indexed | 2024-04-09T13:21:50Z |
| format | Article |
| id | doaj.art-33b6a6b8ffa546458f806afd636efc62 |
| institution | Directory Open Access Journal |
| issn | 2213-5766 |
| language | English |
| last_indexed | 2024-04-09T13:21:50Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Pediatric Surgery Case Reports |
| spelling | doaj.art-33b6a6b8ffa546458f806afd636efc622023-05-11T04:23:55ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662023-06-0193102638Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case reportRuben Visch0Annelies van Zwol1Herjan van der Steeg2Joris Fuijkschot3Anneliese Nusmeier4Department of Pediatric Intensive Care, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The Netherlands; Corresponding author. Department of Pediatric Intensive Care, Radboud University Medical Centre Amalia Children's Hospital, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands.Department of Pediatric Intensive Care, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The NetherlandsDepartment of Pediatric Surgery, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The NetherlandsDepartment of Pediatrics, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The NetherlandsDepartment of Pediatric Intensive Care, Radboud University Medical Centre Amalia Children's Hospital, Nijmegen, The NetherlandsRetrograde colonic irrigation (RCI) using normal saline (NS) is a widely used method to treat constipation, or to prepare the bowels for colorectal surgeries in children. Using large amounts of NS during RCI could induce electrolyte disturbances. A case of extreme hyperchloremic metabolic acidosis following RCI with large volumes of NS in a neonate with Hirschsprung disease has not been described to date.We report a 24 days old patient with Trisomy 21 and Hirschsprung disease, that received RCI twice a day in a NS rectal bolus from day 10 of age, presenting with respiratory and circulatory insufficiency. Lab results showed extreme hyperchloremic acidosis, which was attributed to gastro-intestinal fluid resorption of large volumes of NS. The patient showed clinical improvement after supplementation of sodium bicarbonate and made an uneventful full recovery.This case report emphasizes the need to carefully monitor children for electrolyte disturbances, fluid balance, bodyweight and returned irrigation volumes when RCI is used with large volumes of NS for multiple days.http://www.sciencedirect.com/science/article/pii/S2213576623000647AcidosisBalanced electrolyte solutionCase reportHirschsprung diseaseRetrograde colonic irrigation |
| spellingShingle | Ruben Visch Annelies van Zwol Herjan van der Steeg Joris Fuijkschot Anneliese Nusmeier Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report Journal of Pediatric Surgery Case Reports Acidosis Balanced electrolyte solution Case report Hirschsprung disease Retrograde colonic irrigation |
| title | Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report |
| title_full | Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report |
| title_fullStr | Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report |
| title_full_unstemmed | Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report |
| title_short | Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report |
| title_sort | extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate a case report |
| topic | Acidosis Balanced electrolyte solution Case report Hirschsprung disease Retrograde colonic irrigation |
| url | http://www.sciencedirect.com/science/article/pii/S2213576623000647 |
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