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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Case+Rep
2017 ; 18
(ä): 463-466
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Hyperphosphatemia, a Cause of High Anion Gap Metabolic Acidosis: Report of a Case
and Review of the Literature
#MMPMID28450695
Sadjadi SA
; Pi A
Am J Case Rep
2017[Apr]; 18
(ä): 463-466
PMID28450695
show ga
BACKGROUND Hyperphosphatemia is a common problem in patients with kidney failure.
It is usually mild and rarely severe enough to cause metabolic acidosis on its
own. Besides kidney failure, use of phosphate containing enemas, rhabdomyolysis,
and tumor lysis syndrome are common causes of severe hyperphosphatemia. CASE
REPORT A 74-year-old man with a history of diabetes mellitus type II, arterial
hypertension, and end stage renal disease, who was on hemodialysis and who had
undergone hemicolectomy for ischemic bowel disease, and had not eaten for several
days, developed severe metabolic acidosis, with an anion gap (AG) of 31 meq/L,
-uncorrected for serum albumin. At that time he had a high level of
beta-hydroxybutyrate and severe hyperphosphatemia (16.5 mg/dL). Metabolic
acidosis and hyperphosphatemia were corrected with hemodialysis, confirming the
role of hyperphosphatemia in the development of high AG metabolic acidosis.
CONCLUSIONS Although our patient had many reasons to develop high AG metabolic
acidosis, hyperphosphatemia played a significant role in his acidosis. Severe
hyperphosphatemia is rarely mentioned as a cause of high AG acidosis. It should
be added to the long list of causes of this metabolic disorder. Physiological
basis of acid base changes are discussed.