Metabolic alkalosis is uncommon in pregnancy and is most often the result of severe vomiting. If this is present at the time of delivery, transient metabolic derangement in the fetus can occur, potentially requiring additional organ support. A 22-year-old woman is described, who presented at 37 weeks gestation with a severe metabolic alkalosis, vomiting and acute renal and hepatic impairment. The investigations, management options and maternal and fetal outcome are described.
BenaronDA, YorginPD, LapukS, GibsonR, and DenneryPA. Alkalemia in a newborn infant.J Pediatr1992; 120: 489–494.
5.
GrotegutCA, DandoluV, KatariS, WhitemanVE, Geifman-HoltzmanO, and TeitelmanM. Baking soda pica: a case of hypokalemic metabolic alkalosis and rhabdomyolysis in pregnancy.Obstet Gynecol2006; 107: 484–486.
6.
Ch'ngCL, MorganM, HainsworthI, and KinghamJGC. Prospective study of liver dysfunction in pregnancy in Southwest Wales.Gut2002; 51: 876–880.
7.
de BustrosA, AleppoG, and ZikosD. Hypokalemia in pregnancy: clue to Gitelman syndrome.Endocrinologist2001; 11: 447–450.
8.
HixsonR, and ChristmasD. Use of omeprazole in life-threatening metabolic alkalosis.Intensive Care Med1999; 25: 1201.
9.
PonceP, SantanaA, and VinhasJ. Treatment of severe metabolic alkalosis by ‘acid dialysis’.Crit Care Med1991; 19: 583–585.
10.
HsuS-C, WangM-C, Hsin-LiangL, TsaiM-C, and HuangJ-J. Extreme metabolic alkalosis treated with normal bicarbonate hemodialysis.Am J Kidney Dis2001; 37: 1–4.
11.
MoviatM, PickkersP, van der VoortPHJ, and van der HoevenJG. Acetazolamide-mediated decrease in strong ion difference accounts for the correction of metabolic alkalosis in critically ill patients.Crit Care2006; 10: R14.
12.
CantwellR, Clutton-BrockT, CooperG. Saving mothers’ lives. Reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report on confidential enquiries into maternal deaths in the United Kingdom.BJOG2011; 118(Suppl. 1): 1–203.
