Hyperchloremische metabole acidose bij een patient met een brickerlis

A 79-year-old male with a Bricker loop and chronic renal failure was admitted to hospital because progressive dyspnoea. This was due to severe hyperchloraemic metabolic acidosis. Hyperchloraemic acidosis can occur if urinary diversions are constructed from the colon or ileum. Contact between intestinal mucosa and urine may cause reabsorption of ammonium and chloride, and secretion of bicarbonate. Hyperchloraemic acidosis is rarely seen with an incontinent ileal loop due to its small absorbing surface area and the rapid drainage of urine from the loop. Hyperchloraemic acidosis in a patient with a Bricker loop may point to prolonged contact between the ileum and urine. A loopogram is necessary to investigate the cause. In our patient the loopogram showed that the incorporated bowel segment was too long. After shortening of the Bricker loop, the patient recovered from the hyperchloraemic metabolic acidosis.