Eovaldi B, Zanetti C. Non–Anion Gap Metabolic Acidosis in a Patient With a Pancreaticopleural Fistula. J Am Osteopath Assoc 2011;111(5):344–345. doi: https://doi.org/10.7556/jaoa.2011.111.5.344.
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While acid-base disturbances are known to occur with chronic pancreatitis, few cases have been reported in which non–anion gap metabolic acidosis is caused by pancreaticopleural fistula, a known complication of chronic pancreatitis. The current report describes the case of a 49-year-old African American woman who presented with severe pleuritic chest pain and dyspnea at rest. The patient had a history of alcohol-induced chronic pancreatitis. Her chest radiograph was positive for a large left-sided pleural effusion. Magnetic resonance cholangiopancreatography revealed a small connection between the pancreas and the thoracic cavity. Arterial blood gas analysis revealed non–anion gap metabolic acidosis in the absence of substantial urinary or diarrheal bicarbonate losses. The patient was diagnosed as having non–anion gap metabolic acidosis as a result of a pancreaticopleural fistula and was successfully treated with pancreatic ductal stent placement by means of endoscopic retrograde cholangiopancreatography.
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