Severe Recurrent Alkalemia in a Patient Continuous Cyclic Peritoneal Dialysis T. GARY KENAMOND, M.D. JOHN W. GRAVES, M.D.* KENNETH D. LEMPERT, M.D. ALVIN H. MOSS, M.D. FREDERICK C. WHITTIER, M.D. Morgantown, West Virginia From the Department of Medicine, Section of Nephrology, West Virginia University, Morgan- town, West Virginia. Manuscript accepted May 8, 1985. “Current address and address for reprint re- quests: Section of Nephrology, Bowman Gray School of Medicine, 300 South Hawthorne Road, Winston-Salem, North Carolina 27103. Undergoing Chronic renal failure is commonly associated with acid-base disorders that are corrected with the institution of maintenance peritoneal dialy- sis. Severe shifts in systemic pH that occur in patients undergoing peritoneal dialysis are usually acidemic shifts due to inadequate re- placement of the kidney’s ability to excrete acid and regenerate bicarbonate. Thii report describes a severe alkalemic shii in pH in a patient undergoing continuous cyclic peritoneal dialysis due to a failure of dialysis to substitute for the kidney’s normal response to simple respiratory alkalosis. This case emphasizes that in patients undergoing peritoneal dialysis, physicians must actively provide the “renal com- pensation” for an acid-base disorder and change the dialysis prescrip- tion. Acid-base disturbances are common in patients with end-stage renal disease. Severe shifts in systemic pH in such patients are usually severe acidemic shifts due to the kidneys’ impaired capacity to deal with an acid load. Although severe metabolic alkalosis has been reported in patients with chronic renal failure [ 11, severe alkalemia did not develop as normal respiratory compensation occurred in response to the metabolic disor- der. We repot-t the previously undescribed occurrence of recurrent severe alkalemia due to a failure of “renal compensation” for simple respiratory alkalosis in a patient undergoing continuous cyclic peritoneal dialysis. (CCPD). Unique features of acid-base disorders in patients undergoing peritoneal dialysis are discussed. CASEREPORT End-stage renal disease developed in a 45year-old white man due to long- standing, poorly controlled type I diabetes mellitus. He began undergoing continuous cyclic peritoneal dialysis with standard dialysate (Dianeal PD 2, Travenol Laboratories; Deerfield, Illinois). He did well on this regimen for three months until four days prior to admission when nausea, vomiting, and agitated confusion developed. Laboratory studies on admission showed a serum sodium level of 139 meq/liter, potassium 3.3 meq/liter, chloride 99 meq/liter, carbon dioxide 28 meq/liter, blood urea nitrogen 49 mg/dl, and serum creatinine 6.8 mg/dl. Arterial blood gas values with the patient breathing room air were: pH 7.73, partial pressure of oxygen 105 mm Hg, and partial pressure of carbon dioxide 18 mm Hg. Chest radiography and culture of blood and peritoneal and cerebrospinal fluid revealed no abnor- malities. Peritoneal dialysis was suspended temporarily and intravenous normal saline was administered. Repeated arterial blood gas determination revealed a pH of 7.65, partial pressure of oxygen of 101 mm Hg, partial pressure of carbon dioxide of 23 mm Hg, and bicarbonate of 28. A rebreathing mask was applied and after four hours arterial blood gas values were pH 7.43, partial pressure of oxygen 79 mm Hg, partial pressure of 548 September 1988 The American Journal c If Medicine Volume 81