A case of severe electrolyte and acid-base disorders treated by hemodialysis after fluminant hepatitis

Abstract

Less common indications for dialysis therapy include life-threatening electrolyte and acid-base disorders. We encountered a case of severe metabolic alkalosis, hypernatremia and hypokalemia after treatment of fluminant hepatitis. A 31-year-old man with arterial fibrillation was admitted to our hospital because of severe liver dysfunction. He was diagnosed as having fluminant hepatitis and treated with three sessions of plasma exchange. Then he received steroid therapy and infusion of fresh frozen plasma. Although he recovered from hepatic failure, severe metabolic alkalosis, hypernatremia and hypokalemia emerged. These disorders were considered mainly due to iatrogenic factors such as plasma exchange and steroid therapy as well as administration of glycyrrhizin. Since cardiac and renal functions were also diminished, it seemed difficult to treat these disorders by conservative therapy. Two sessions of hemodialysis successfully corrected the electrolyte and acid-base disorders.