Non-anion gap metabolic acidosis in a patient with a pancreaticopleural fistula.

While acid-base disturbances are known to occur with chronic pancreatitis, few cases have been reported in which non-anion gap metabolic acidosis is caused by pancreaticopleural fistula, a known complication of chronic pancreatitis. The current report describes the case of a 49-year-old African American woman who presented with severe pleuritic chest pain and dyspnea at rest. The patient had a history of alcohol-induced chronic pancreatitis. Her chest radiograph was positive for a large left-sided pleural effusion. Magnetic resonance cholangiopancreatography revealed a small connection between the pancreas and the thoracic cavity. Arterial blood gas analysis revealed non-anion gap metabolic acidosis in the absence of substantial urinary or diarrheal bicarbonate losses. The patient was diagnosed as having non-anion gap metabolic acidosis as a result of a pancreaticopleural fistula and was successfully treated with pancreatic ductal stent placement by means of endoscopic retrograde cholangiopancreatography.