Administration of amino acid agents is effective to prevent critical alkalosis during sodium bicarbonate irrigation in patients with pseudomyxoma peritonei

Soshi Kusunoki, Hiroshi Kaneda, Shin Suga, Miki Kimura, Yasuhisa Terao, Kiyoko Kato, Takashi Yao, Satoru Takeda

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Abstract

Pseudomyxoma peritonei (PMP) is a rare disease, which presents with large amounts of mucinous ascites. The primary tumor is usually a mucinous cystadenoma or cystadenocarcinoma of the appendix. The main treatment is surgical resection of the tumor and removal of the mucus, but it can be challenging to remove mucus completely. Intraperitoneal irrigation with 7% sodium bicarbonate was effective as a mucolytic agent. However, it has been reported that alkalosis can occur during irrigation. Currently there is a paucity of evidence regarding the mechanisms that lead to alkalosis. We report our experience with two cases of PMP who underwent intraperitoneal irrigation with 7% sodium bicarbonate. In one case, critical alkalosis (pH 7.56, HCO3− 35.2 mmol/ml) occurred after irrigation with 7% sodium bicarbonate and gradually improved over time. Blood gas abnormalities resolved during the postoperative period. A salpingo-oophorectomy, omentectomy, and appendectomy were performed. Review of the histology confirmed a mucinous tumor of low malignant potential of the appendix. In the second described case, we administered amino acid agents intravenously followed by intraperitoneal irrigation with 7% sodium bicarbonate. Critical alkalosis did not occur. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and appendectomy were performed. Review of the histology confirmed an appendiceal mucinous cystadenocarcinoma with metastases in bilateral ovaries. Mucus in the peritoneal cavity was almost completely removed in both these cases. Both patients are doing well with no evidence of recurrence. Administration of amino acid agents followed by intraperitoneal irrigation with 7% sodium bicarbonate appears to be an effective therapy to prevent critical alkalosis in patients with PMP.
Original languageEnglish
Pages (from-to)74
Number of pages78
JournalInternational Cancer Conference Journal
Volume1(2)
Publication statusPublished - Feb 9 2012

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