DOI: 10.12890/2025_005276

An unexpected cause of severe metabolic acidosis

Authors

  • Suzanne K. Veneman Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  • Stephanie E. Veneman Department of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
  • Hardjit Kharagjitsing Department of Nephrology, Horacio Oduber Hospital, Oranjestad, Aruba
  • Thiemo F. Veneman Department of Intensive Care Medicine, Horacio Oduber Hospital, Oranjestad, Aruba

thiemoveneman@gmail.com

Keywords

Metabolic acidosis, hydroxyurea, anion gap

Abstract

Introduction: Metabolic acidosis is a potentially serious electrolyte disorder with a variety of potential causes. It can cause serious harm to multiple organ systems with irreversible damage and if untreated it can even cause mortality.
Case description: A 66-year-old man presented at the emergency room of our hospital because of abdominal pain, nausea, and vomiting for 3 days, with no diarrhoea. Physical examination showed a sick, restless, shaking, middle-aged man with a maximal eye-motor-verbal score. He had a history of polycythaemia vera but had been lost to follow-up. He was clinically dehydrated with extremely dry mucous membranes and complaining of thirst. Laboratory investigations showed severe metabolic acidosis with a pH of 7.08 and electrolyte disturbances with hyperkalaemia and hyponatremia. The treatment with a high dose of hydroxyurea had been re-started 14 days before presentation at the emergency room.
Conclusion: We believe that the recent initiation of the treatment with a (too) high dose of hydroxyurea with consequently gastrointestinal complications could have been the underlying cause. In addition to the indirect effect of dehydration resulting from the gastrointestinal side effects of hydroxyurea, another known but rarely reported adverse effect is (tubular) renal dysfunction, which may have contributed to the progression of metabolic acidosis. The exact mechanisms by which hydroxyurea induces metabolic acidosis remain unknown. It is important to recognize hydroxyurea as the culprit of the development of severe metabolic acidosis. If unrecognized, metabolic acidosis can worsen and cause irreversible damage.

View the entire article

Downloads

References

  1. Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol 2010;6:274-285. doi: 10.1038/nrneph.2010.33
  2. Matyukhin I, Patschan S, Ritter O, Patschan D. Etiology and Management of Acute Metabolic Acidosis: An Update. Kidney Blood Press Res 2020;45:523-531. doi: 10.1159/000507813
  3. Fenves AZ, Emmett M. Approach to Patients With High Anion Gap Metabolic Acidosis: Core Curriculum 2021. Am J Kidney Dis 2021;78:590-600. doi: 10.1053/j.ajkd.2021.02
  4. Tefferi A, Vannucchi AM, Barbui T. Polycythemia vera: historical oversights, diagnostic details, and therapeutic views. Leukemia 2021;35:3339-3351. doi: 10.1038/s41375-021-01401-3
  5. Fox S, Griffin L, Robinson Harris D. Polycythemia Vera: Rapid Evidence Review. Am Fam Physician 2021;103:680-687
  6. Zorginstituut Nederland. Farmacotherapeutisch Kompas [Internet]. Available from: https://www.farmacotherapeutischkompas.nl/
  7. Evans M, Lewis RD, Morgan AR, Whyte MB, Hanif W, Bain SC, et al. A Narrative Review of Chronic Kidney Disease in Clinical Practice: Current Challenges and Future Perspectives. Adv Ther 2022;39:33-43. doi: 10.1007/s12325-021-01927-z
  8. Stevens MR. Hydroxyurea: an overview. J Biol Regul Homeost Agents 1999;13:172-175.

Published

2025-05-21

Issue

Vol. 12 No. 6 (2025)

Categories

How to Cite

1.
Veneman SK, Veneman SE, Kharagjitsing H, Veneman TF. An unexpected cause of severe metabolic acidosis. EJCRIM [Internet]. 2025 May 21 [cited 2026 Nov. 3];12(6). Available from: https://ejcrim.com/index.php/ejcrim/article/view/5276

Most read articles by the same author(s)