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Severe metabolic acidosis and hyperkalemia after peptide receptor radionuclide therapy. A case report, review of the literature and proposed treatment algorithm

Peptide receptor radionuclide therapy (PRRT) has been increasingly used in the treatment of patients with well-differentiated neuroendocrine neoplasms (WD-NENs), but electrolyte abnormalities during prophylactic aminoacid (AA) infusion can complicate its administration. We describe a case of AA-induced acidosis and hyperkalemia associated with PRRT. We tailored an oral and intravenous sodium bicarbonate regimen for pre-emptive treatment prior to subsequent PRRT session, thereby preventing hospitalization. We provide a relevant review of the literature and our treatment algorithm, that can serve as a point of reference in treatment of this life-threatening complication of PRRT.