{'fraction_non_alphanumeric': 0.056074766355140186, 'fraction_numerical': 0.032985156679494226, 'mean_word_length': 4.814696485623003, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Correction of Metabolic Alkalosis and Elevated Calcium Levels by Sodium Chloride in a Hemodialysis Patient With Inadequate Chloride Intake

A 61-year-old male patient had been receiving hemodialysis for 6 years because of diabetic nephropathy and was anuric. He underwent total laryngectomy for vocal cord cancer and was receiving tube feeding through a gastrostoma. Gradually, albumin-corrected calcium (cCa; cCa = serum calcium + 0.8 × [4 – serum albumin (g/dL)]) concentrations increased to 10.2mg/dL at around 80 postoperative days. Predialysis measurements of serum albumin, phosphate, sodium, chloride, and plasma bicarbonate were, respectively, 2.4 g/dL, 4.1mg/dL, 134mEq/L, 93mEq/L, and 31.3mmol/L. Ionized calcium was 1.27mmol/L (slightly elevated). The patient had no history of vomiting or medication, which might cause elevated serum Ca levels or metabolic alkalosis such as calcium carbonate or active vitamin D. Intact PTH was 31pg/mL (15–65pg/mL for healthy adults) immediately after laryngectomy. He was not immobile. He underwent 4-h hemodialysis thrice a week using Kindaly AF-2 (Fuso Pharmaceutical Inds., Ltd., Osaka, Japan) as dialysate (Na 140mEq/L, Cl 110mEq/L, Ca 3.0mEq/L, and bicarbonate 30mEq/L). He ingested enteral nutrients (Renalen MP; Meiji Seika Pharma Co. Ltd., Tokyo, Japan) of as much as 1600kcal per day, which typically contains 80mg of calcium, 41.7mEq of sodium, and only 4.5mEq of chloride. Consequently, chloride deficiency was suspected to be the cause ofmetabolic alkalosis and following elevated serum Ca levels, so 3g of sodium chloride was added to his enteric nutrients. Thereafter, chloride and bicarbonate returned to the normal range, and the corrected calcium became 8.9mg/dL (Fig. 1). Serum phosphate was almost always below 5mg/dL, except immediately after surgery.