METABOLIC COMPLICATIONS OF THE USE OF STOMACH FOR URINARY RECONSTRUCTION

A total of 34 children with normal renal function underwent either gas trocystoplasty or continent urinary reservoirs with stomach at our ins titutions. Severe hypochloremic hypokalemic metabolic alkalosis develo ped in 2 patients, manifested by intractable seizure disorder in 1 and altered mental status with respiratory depression in 1. Symptoms deve loped at 4 and 6 months, respectively. Despite severe alkalosis, urina ry pH was less than 5.0 and fractional excretion of chloride remained high in both patients. Resuscitation with sodium chloride, arginine hy drochloride and potassium chloride restored electrolyte balance in les s than 48 hours in both patients. Serum gastrin was slightly elevated in 1 patient (137 pg./ml., normal 0 to 125) who responded to long-term histamine-blocker therapy. The other patient had significant hypergas trinemia (624 pg./ml.) with secondary hyperaldosteronism. Maximum dose s of histamine blockers, oral replacement of sodium chloride and potas sium chloride, and the proton pump inhibitor omeprazole failed to cont rol recurrent bouts of severe hypochloremic metabolic alkalosis. This patient ultimately underwent removal of three-quarters of the gastric augmentation and replacement with ileum. Postoperatively, serum gastri n levels and electrolytes reverted to normal. The pathophysiology of t his potentially lethal complication is further discussed.