Abstract
We report two patients with severe motor and intellectual disabilities (SMID) who exhibited aggravate paroxysmal discharges on electroencephalogram (EEG) during metabolic alkalosis. Case 1 was a 52-year-old male with cerebral palsy and epilepsy. He had frequent vomiting due to gastroesophageal regurgitation and had his gastric juice drained from the gastrostomy to prevent vomiting. Then his venous blood gas analysis showed metabolic alkalosis : pH. 7.59, HCO3-. 62.8 mmol/L, K+ 2.81 meq/L and Cl-. 81 meq/L. Though he had no seizure, his EEG showed frequent paroxysmal discharges in the right frontal area. Case 2 had bleeding from arteriovenous malformation in his brain stem and had convulsions at neonatal period. His seizures were controlled by phenobarbital. But he had frequent vomiting and had also his gastric juice drained from the gastrostomy to relieve vomiting. At the age of 4 years and 11 months, EEG showed frequent continuous paroxysmal discharges at his right posterior head area. His venous blood gas analysis showed metabolic alkalosis : pH.7.54,HCO3-38mmol/L,K+ 2.82 meq/L, Cl- 95 meq/L, In both cases, treatment of metabolic alkalosis reduced the frequency of paroxysmal discharges. When patient with SMID showed aggravated paroxysmal discharges on EEG, attention should be paid to conditions that induce metabolic alkalosis, such as frequent vomiting.
