Conventional bicarbonate haemodialysis in postgastrocystoplasty metabolic alkalosis.

Metabolic alkalosis (MA) is an uncommon condition in chronic kidney disease (CKD) patients. The commonest cause is gastric acid loss. The normal compensatory urinary bicarbonate loss is absent in patients with CKD, and haemodialysis, being an alkalising process, is even more challenging in such a situation. We report a 44-year-old man with MA and acute-on-chronic renal failure presenting with uraemia and dehydration caused by acid loss from a previous gastrocystoplasty and obstructive uropathy. The MA was safely and quickly reversed through use of conventional haemodialysis and normal bicarbonate dialysate of 35 mmol/L. We also prevented further MA with the use of a proton pump inhibitor.