Metabolic Alkalosis Associated Fluid and Electrolyte Disorders Revealing an Upper Digestive Tract Condition

We report a case of a 66-year-old female patient with ischemic cardiomyopathy, who was referred in Nephrology Department for the management of a renal impairment associated-severe hyponatremia, hypokalemia and hypochloremia that occurred after vomiting episodes evolving since 1 month. On admission, the patient was calm with a psychomotor retardation occurring in a context of moderate dehydration. Arterial blood gas analysis outlined a severe metabolic alkalosis. An extra-renal cause of these metabolic disorders was retained on the basis of a metabolic alkalosis not featuring an HBP and the urinary ionogram revealing low urine sodium, potassium and chlorine. The seriousness of the clinical course was made by the underlying cardiomyopathy condition, hypocalcemia, severe consistent hypokaliemia and compensatory hypoventilation. The evolution was unremarkable after 4 days of hydro-sodium deficit correction with potassium chloride adjunction. It featured a drowsiness disappearance and a good temporal-spatial orientation. The clinical examination revealed a good general condition associating a good hydration and hemodynamic state. The lab findings showed a normal plasma sodium levels and increased kalemia and chloremia. Upper digestive endoscopy outlined a hiatal hernia associated-erosive bulbitis indicating an eradicator treatment of Helicobater pylori based on a double dose of PPI (Omeprazole 20 mg) and dual antibiotic therapy (Amoxicillin and Clarithromycin) combined with domperidone.