Abstract
In July 2007, a 72-year-old man with a 4-year history of renal insufficiency started hemodialysis due to post-infectious glomerulonephritis. The patient underwent surgery for rupture of chronic aortic dissection in early August and hemodialysis was continued. Due to prolonged postoperative consciousness disturbance, enteral feeding was started and PEG was inserted in late November. To prevent repeated aspiration, the enteral products were changed from Renalen® and Q. P K-4S® to Medief® Pushcare, a gel-type formula. However, the patient subsequently developed severe metabolic alkalosis and hyperkalemia (pH 7.60, HCO3- 36.8 mEq/L, K 6.5 mEq/L). Discontinuation of this product and feeding with Terumeal® PG soft rapidly improved both metabolic alkalosis and hyperkalemia. We speculated that the higher concentration of sodium compared to chloride in Medief® Pushcare contributed to its alkaline property and caused severe alkalemia in this case. The concentration of potassium was also higher in this product. Since the need for enteral feeding in dialysis patients is steadily increasing in accordance with diversification of the medical backgrounds of these patients, we must continue to pay careful attention in choosing the most suitable products for each patient.
