DAVID W. NIERENBERG, M.D.
To the editor: In their excellent article in the March 1979 issue, Gabow, Moore, and Schrier (1) describe six cirrhotic patients with ascites who developed reversible hyperchloremic metabolic acidosis without significant anion gaps when treated with spironolactone. As the authors point out, patients with severe liver disease are likely to develop a low serum-bicarbonate concentration for several reasons, including renal acidification defects, respiratory alkalosis, and alcoholic diarrhea.
We recently were asked to see a similar patient, a 67-year-old woman with alcoholic cirrhosis, ascites, and normal renal function, who developed a severe hyperchloremic acidosis (HCO3, 8 meq/L; pH, 7.20) with no
NIERENBERG DW. Spironolactone and Metabolic Acidosis. Ann Intern Med. ;91:322. doi: 10.7326/0003-4819-91-2-321_3
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Published: Ann Intern Med. 1979;91(2):322.
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