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Background <p>Suicidal intoxications are frequently encountered in the emergency department; however, atypical laboratory findings may complicate and delay diagnosis. Severe hyperchloremia associated with profound metabolic acidosis is rare and requires careful evaluation, including consideration of analytical interference and uncommon etiologies.</p> Aims <p>To present a case of unexplained severe hyperchloremia and hyperchloremic metabolic acidosis secondary to corrosive substance ingestion and to highlight the potential role of early hemodialysis in refractory metabolic disturbances.</p> Methods <p>A 56-year-old female patient was admitted with preliminary diagnoses of seizure or cerebrovascular event after intentional ingestion of multiple medications, including rasagiline, alprazolam, and levodopa, together with a household cleaning product. Venous blood gas analysis revealed severe metabolic acidosis (pH 7.03). Initial serum chloride was 165&#xa0;mmol/L and increased to 200&#xa0;mmol/L on repeat testing. During clinical follow-up, excessive oral secretions and esophageal burning raised suspicion of corrosive ingestion. Despite supportive and medical management, acidosis and hyperchloremia persisted. Hemodialysis was initiated 4&#xa0;h after presentation and performed for 2&#xa0;h.</p> Results <p>Following hemodialysis, metabolic acidosis improved significantly. Endoscopy demonstrated Grade 2A corrosive esophagitis according to the Zargar classification. Imaging showed no evidence of perforation or mediastinitis but findings consistent with aspiration pneumonia.</p> Conclusions <p>Corrosive substance ingestion should be considered in patients presenting with unexplained severe hyperchloremia and hyperchloremic metabolic acidosis. Early hemodialysis may be an effective therapeutic option in refractory cases. Markedly elevated chloride levels require simultaneous verification to exclude measurement error or analytical interference and prevent diagnostic delay.</p>

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The path to diagnosis of unexplained severe hyperchloremia: a case of corrosive substance ıngestion and early hemodialysis

  • 期刊论文

  • 发表日期：

    2026年4月16日

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  • K. Sener,
  • R. Baysal,
  • E. Polatdemir,
  • İ Beydilli,
  • S. Paltacı,
  • S. Veske,
  • T. Çolak

摘要

Background

Suicidal intoxications are frequently encountered in the emergency department; however, atypical laboratory findings may complicate and delay diagnosis. Severe hyperchloremia associated with profound metabolic acidosis is rare and requires careful evaluation, including consideration of analytical interference and uncommon etiologies.

Aims

To present a case of unexplained severe hyperchloremia and hyperchloremic metabolic acidosis secondary to corrosive substance ingestion and to highlight the potential role of early hemodialysis in refractory metabolic disturbances.

Methods

A 56-year-old female patient was admitted with preliminary diagnoses of seizure or cerebrovascular event after intentional ingestion of multiple medications, including rasagiline, alprazolam, and levodopa, together with a household cleaning product. Venous blood gas analysis revealed severe metabolic acidosis (pH 7.03). Initial serum chloride was 165 mmol/L and increased to 200 mmol/L on repeat testing. During clinical follow-up, excessive oral secretions and esophageal burning raised suspicion of corrosive ingestion. Despite supportive and medical management, acidosis and hyperchloremia persisted. Hemodialysis was initiated 4 h after presentation and performed for 2 h.

Results

Following hemodialysis, metabolic acidosis improved significantly. Endoscopy demonstrated Grade 2A corrosive esophagitis according to the Zargar classification. Imaging showed no evidence of perforation or mediastinitis but findings consistent with aspiration pneumonia.

Conclusions

Corrosive substance ingestion should be considered in patients presenting with unexplained severe hyperchloremia and hyperchloremic metabolic acidosis. Early hemodialysis may be an effective therapeutic option in refractory cases. Markedly elevated chloride levels require simultaneous verification to exclude measurement error or analytical interference and prevent diagnostic delay.