Uretero sigmoidostomy the electrolyte status is:
a. The electrolyte abnormality that occurs with the ileum and colon is hyperchloremic metabolic acidosis .
b. Symptoms in those in whom the syndrome is severe include easy fatigability, anorexia, weight loss, polydipsia, and lethargy.
c. Those with ureterosigmoidostomies also have an exacerbation of diarrhea.
d. The mechanism of hyperchloremic metabolic acidosis is due to the ionized transport of ammonium. Ammonium substitutes for sodium in the Na+-H+ antiport.
e. The exchange of the weak acid NH4 for a proton is coupled with the exchange of bicarbonate for chloride.
f. Thus, ammonium chloride is absorbed across the lumen into the blood in exchange for carbonic acid (i.e., CO2 and water). Ammonium may also gain entry to the blood from bowel lumen through potassium channels.
g. The treatment of hyperchloremic metabolic acidosis involves administration of alkalizing agents or blockers of chloride transport.
h. Alkalinization with oral sodium bicarbonate is effective in restoring normal acid-base balance.
i. Oral administration of bicarbonate may not be tolerated particularly well, however, because it can produce considerable intestinal gas.
j. An effective alternative is sodium citrate and citric acid solution (Bicitra or Shohl's solution) used together; however, many patients do not care for the taste.
k. Nicotinic acid may be given in a dose of 400 mg three or four times a day.
l. The drug should not be used in patients with peptic ulcer disease or significant hepatic insufficiency.
m. Side effects that may be observed include exacerbation of liver dysfunction, exacerbation of peptic ulcer disease, headaches, and double vision.