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Life-Threatening Metabolic Acidosis From Cholestyramine in an Infant With Renal Insufficiency

Marilyn Pattison, MD; Stanley M. Lee, MD
Am J Dis Child. 1987;141(5):479-480. doi:10.1001/archpedi.1987.04460050021018.
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Sir.—Cholestyramine is a bile acid—sequestrant antilipemic agent whose mechanism of action is that of an ion exchange resin. Chloride is released from the resin and is absorbed in exchange for bicarbonate across the bowel wall. Normally the increased chloride (acid) load is excreted by the kidneys, but in the presence of renal insufficiency, hyperchloremic acidosis may develop.1 Cholestyramine has been of value in the treatment of children with cholestasis resulting from biliary atresia and in the treatment of intractable diarrhea in infants.2,3 There are scattered case reports documenting the occurrence of hyperchloremic acidosis associated with cholestyramine therapy.4,5 We report a case of life-threatening metabolic acidosis in an infant with renal insufficiency.

Patient Report.—A 5-week-old male infant was admitted for poor feeding and weight loss. The child was the product of an uneventful full-term pregnancy and weighed 2700 g at birth. However, the child incurred significant


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