Q J Med 2002; 95: 37-40
© 2002 Association of Physicians
Acute renal failure and metabolic disturbances in the short bowel syndrome
From the Department of Renal Medicine, Lister Hospital, Stevenage, UK
Received 31 August 2001 and in revised form 26 October 2001
Background: Short bowel syndrome (SBS) describes a malabsorptive state caused by extensive loss of small intestinal length.
Aim: To improve understanding of the metabolic complications of SBS.
Design: Observational study of five patients with SBS who presented with acute renal failure.
Results: Acute renal failure in our patients was predominantly due to salt and fluid depletion, and sepsis. Electrolyte imbalance was a major cause of morbidity. Metabolic acidosis was seen in three patients, and may arise from excessive gastrointestinal bicarbonate loss, compounded by impaired renal homeostasis. Our patients also manifested disturbances of calcium and magnesium homeostasis.
Discussion: Patients with SBS are at high risk of renal failure. Prevention of this complication requires close monitoring and the maintenance of sodium homeostasis through increased intake and measures to reduce loss (e.g. anti-motility agents and large bowel re-anastomosis), and calcium, magnesium and vitamin D supplementation.
Address correspondence to Dr P. Warwicker, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB. e-mail: p.warwicker{at}doctors.org.uk