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Volume 7, Pages 75-79
Case Study

Intestinal Ileus as a Possible Cause of Hypobicarbonatemia

Division of Nephrology and Hypertension, Northwestern University Feiberg School of Medicine, Chicago, IL, USA

Received 3 December 2006; Revised 3 January 2007; Accepted 6 January 2007

Academic Editor: Patricia Vallés

Copyright © 2007 Andres Serrano et al.


The possible occurrence of metabolic acidosis in patients with intestinal ileus is not well recognized. We describe a patient with acute alcohol-induced pancreatitis and a large transverse colon ileus in which plasma bicarbonate dropped rapidly in the absence of an increase in the plasma anion gap. The urinary anion gap and ammonium excretion were consistent with an appropriate renal response to metabolic acidosis and against the possibility of respiratory alkalosis. The cause of the falling plasma bicarbonate was ascribed to intestinal bicarbonate sequestration owing to the enhancement of chloride-bicarbonate exchange in a dilated paralyzed colon.