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Two patients are presented with complete external biliary fistula, one traumatic in origin and another which followed biliary tract surgery. Both patients developed a characteristic clinical picture of weakness, anorexia, apathy, confusion, circulatory and renal failure with hyperkalemia and finally vascular collapse with severe cardiac arrhythmias. This complication was shown to be secondary to Na+ and HCO3 depletion. Attention is called to the potential danger of this syndrome in patients with hypertensive cardiovascular or hepatic disease routinely deprived of sodium chloride in their chronic management who undergo biliary tract surgery followed by common duct drainage.
Bile obtained from these patients showed Na+ concentration which was consistently greater than that of serum. In the first case, average daily Na+ loss through the fistula was 262 mEq.; in the second, 72 mEq. Both patients showed dramatic improvement with Na+ replacement and correction of acidosis.
It may be concluded that there is a potential danger of severe hyponatremia in patients with external biliary fistula. Electrolyte losses by this mechanism should be measured and replaced.
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Barry, K. G.: To be published.
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Received: September 8, 1961
© 1962 Published by Elsevier Inc.