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Hyperchloremic Metabolic Acidosis With Cholestyramine Therapy for Biliary Cholestasis

Am J Dis Child. 1978;132(12):1220. doi:10.1001/archpedi.1978.02120370072021.
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Cholestyramine is a hydrophilic, insoluble anion-exchange resin that removes substantial amounts of bile acids from the enterohepatic circulation by binding them in a compound that cannot be reabsorbed through the intestine. It has been used without complication in children with biliary cholestasis associated with biliary atresia1 and in the treatment of intractable diarrhea in infants.2.3 The case reported here deals with hyperchloremic acidosis as a complication of cholestyramine therapy in a 6-month-old infant with intercurrent infection, and adds to other reports of this finding by Hartline,4 Primak and McGurk,5 and Kleinman.6

Report of a Case.—The patient was first referred to the pediatric consultation service at Mt Zion Hospital in San Francisco at the age of 10 weeks, when a diagnosis of intrahepatic cholestasis secondary to intrahepatic biliary atresia was made and confirmed by open liver biopsy. Cholestyramine therapy was begun six weeks prior to this


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