Hyperchloremic metabolic acidosis is a known complication following ileal conduit urinary diversion, often arising from urinary reabsorption in the ileum, which leads to chloride retention and bicarbonate loss and, though often asymptomatic, can produce clinically significant symptoms, particularly in patients with underlying renal impairment. A 75-year-old woman with a history of bladder cancer underwent cystectomy with ileal conduit diversion and presented on postoperative day 47 with anorexia, hypotension, and weight loss; laboratory findings revealed hyperchloremic metabolic acidosis with elevated serum chloride. The patient's acidosis gradually improved with sodium bicarbonate and Ringer's solution, stabilizing her blood pressure, creatinine, and acid-base balance, and she was discharged with outpatient follow-up. This case highlights the role of urinary reabsorption in the ileal conduit as a cause of bicarbonate loss and acidosis exacerbation, particularly in patients with renal impairment, while the sodium-chloride gap, although supplementary, provided additional insights into acidosis progression and facilitated early detection in this case. Hyperchloremic metabolic acidosis following ileal conduit diversion warrants vigilant monitoring and timely intervention, with bicarbonate supplementation playing a central role in treatment to optimize clinical outcomes in patients with compromised renal function.
Keywords: acute interstitial nephritis (ain); acute kidney injury (aki); acute tubular injury (ati); atypical anorexia; chronic kidney disease (ckd); hyperchloremic metabolic acidosis; ileal conduit; intermittent hemodialysis (ihd); vancomycin-induced nephrotoxicity (vin).
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