A 55-year-old male with PBC(primary biliary cirrhosis) and non gap metabolic acidosis

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Published on Feb 22, 2022
CC - A 55-year-old Hispanic male with primary biliary cirrhosis and non gap metabolic acidosis

HPI - 55 -year-old Hispanic male presented to clinic for follow up of cirrhosis - He initially presented to the clinic about 2 years ago with complaints of yellow discoloration of skin, abdominal distention and skin dryness/pruritus.. He was diagnosed with Primary Biliary cirrhosis -(PBC) with portal HTN and ascites during evaluation of cholestatic pattern elevated LFT. He was started on cholestyramine 4â€‰g PO TID for his pruritus from chronic cholestasis. He was started on Aldactone for htn, edema and ascites management.

PMH - PBC, Seizure, Dyslipidemia and HTN

MEDS - Lipitor, Coreg, Aldactone, Cholestyramine, valproate

EXAM - BP 139/75 mmHg, icterus of skin,1 plus peripheral edema , the abdomen was soft, non-tender, distended, positive ascites, splenomegaly was noted.

LABS-

ABG -serum pH was 7.09, HCO3, 14 mM/l, CO2, 26 mmHg

BMP -Na+, 140 mM/l, potassium 5.6â€‰mmol/L, chloride 120â€‰mmol/L, and bicarbonate 16â€‰mmol/L . serum calcium and uric acid is normal

URINE - The urine pH was 5.3 and the urinalysis was positive for bilirubin, proteinuria (1.0â€‰g/L). urine electrolytes were as follows: sodium 48â€‰mmol/L, potassium 30â€‰mmol/L, and chloride 57â€‰mmol/L (urine anion gap 21â€‰mmol/L).. No phosphaturia or glycosuria was noted.

LFT - alkaline phosphatase 1,366 IU/L, alanine transaminase 244 IU/L, aspartate transaminase 183 IU/L, gamma-glutamyl transferase 727 IU/L, total bilirubin 3.8mg/dL, direct bilirubin 2.1 mg/dL, and Albumin 3.5 g/dL.

NEXT STEP IN MANAGEMENT OF THIS PATIENT NON GAP HYPERCHOLREMIC METABOLIC ACIDOSIS IS

A. stop cholestyramine, start Lasix, bicarbonate supplement
B. stop Aldactone
C. start Lasix, bicarbonate supplement
D. stop Valproate

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https://renal.medcase.com/free_cme/a-55-year-old-male-with-pbcprimary-biliary-cirrhosis-and-non-gap-metabolic-acidosis/