Extreme hyperchloremic metabolic acidosis following retrograde colonic irrigations in a neonate: a case report

Retrograde colonic irrigation (RCI) using normal saline (NS) is a widely used method to treat constipation, or to prepare the bowels for colorectal surgeries in children. Using large amounts of NS during RCI could induce electrolyte disturbances. A case of extreme hyperchloremic metabolic acidosis following RCI with large volumes of NS in a neonate with Hirschsprung disease has not been described to date. We report a 24 days old patient with Trisomy 21 and Hirschsprung disease, that received RCI twice a day in a NS rectal bolus from day 10 of age, presenting with respiratory and circulatory insufficiency. Lab results showed extreme hyperchloremic acidosis, which was attributed to gastro-intestinal fluid resorption of large volumes of NS. The patient showed clinical improvement after supplementation of sodium bicarbonate and made an uneventful full recovery. This case report emphasizes the need to carefully monitor children for electrolyte disturbances, fluid balance, bodyweight and returned irrigation volumes when RCI is used with large volumes of NS for multiple days. We here present a case of extreme hyperchloremic metabolic acidosis following retrograde colonic irrigation with large volumes of normal saline.