Metabolic Alkalosis After Massive Blood Transfusion

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Abstract
METABOLIC alkalosis is commonly observed after major surgery. It is usually due to loss of acid by gastric suction and increased bicarbonate regeneration by the kidneys.1 We report a case in which the administration of large amounts of blood provided an exogenous load of bicarbonate precursors that worsened a preexisting alkalosis. The latter was promptly corrected by hemodialysis. Report of a Case A 48-year-old man maintained on hemodialysis since 1969 was admitted to the hospital on June 12, 1975, with the acute onset of bleeding in the upper portion of the gastrointestinal tract that was shown, on endoscopic examination, to originate from a duodenal ulcer. He received antacids and 9 units of leukocyte-poor packed red blood cells (RBCs) during the following week because of intermittent bleeding. On the 12th day, he underwent vagotomy, pyloroplasty and oversewing of a bleeding duodenal ulcer. One week later, a gastrostomy was done after