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Metabolic Acidosis after Hyperalimentation with Casein Hydrolysate: Occurrence in a Starved Patient

D. S. FRALEY, M.D.; S. ADLER, M.D.; F. BRUNS, M.D.; and D. SEGAL, M.D.
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▸Request for reprints should be addressed to Donald S. Fraley, M.D.; Montefiore Hospital, 3459 Fifth Avenue; Pittsburgh, PA 15213.

Pittsburgh, Pennsylvania

© 1978 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1978;88(3):352-354. doi:10.7326/0003-4819-88-3-352
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A 29-year-old woman with short bowel syndrome and prolonged starvation developed hyperchloremic metabolic acidosis after initiation of hyperalimentation with a casein hydrolysate solution. The acidosis was not due to bicarbonate loss but was associated with diminished ability of the kidney to increase urinary acid excretion, particularly titratable acidity. Supplemental parenteral bicarbonate administration was necessary for two weeks until urinary acid excretion rose to normal.





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