Acidemia in Short Bowel Syndrome
53 yM with hx of Protein C Deficiency (on LMWH), remote hx of mesenteric thrombosis and bowel resection (’81) admitted for severe mixed anion gap and non-anion gap acidosis (bicarb of 7 and ΔΔ <1).
Teaching points:
– estimate AG using albumin even though the measured AG appears normal- there may be an inapparent AG
– calculate ΔΔ (if there is an AG and low bicarb)= ΔAG (calculated AG- estimated AG)/ ΔHCO3 (24- measured HCO3). If <1 indicates both AG and non AG acidosis
– some of the causes of acidemia in Short Bowel Syndrome could be GI losses (non gap acidosis), D- lactate acidosis (gap acidosis without elevated lactate) due to bacterial proliferation producing D-lactate
AJG Review article on Short Bowel Syndrome and another review on Short Bowel Syndrome.