Alkaline Lemonade Poisoning: A Case Report

Background:

First-line treatment for acute gastroenteritis (AGE) are oral rehydration solutions. These prepared solutions are recommended by WHO and ESPGHAN since they assure a right replacement of hydro-electrolitic disbalance, advising against other alternatives.

‘Alkaline lemonade’ is a home-made alternative to prepared solutions, made with water, sugar, salt, lemon and baking soda. It has been widely recommended and extensively used in Spain due to its availability and effectiveness.

We report a case of metabolic alkalosis and electrolytic disturbances in a patient with AGE, who was treated with ‘alkaline lemonade’.

Case Presentation:

A previously healthy 11-month-old boy was brought to the Emergency Department with an AGE caused by Norovirus. On his arrival he was afebrile and hemodynamically stable, with signs of moderate dehydration. Admission blood tests revealed metabolic alkalosis (pH 7.54, pCO2 45.7 mmHg and bicarbonate 38.4 mmol/L), hypokalemia (2.3 mmol/L) and hypernatremia (145 mmol/L), with normochloremia, were observed in first blood tests. The electrocardiogram showed flat T-waves in all derivations, without any other changes. He was admitted to the Paediatric Intensive Care Unit, where a fast correction of hypokalemia was performed, with disappearance of electrocardiogram disturbances. He received intravenous fluid therapy until complete recovery of detected alterations.

Due to the importance of disturbances, tubulopathies were ruled out. When the parents were asked about their son’s home management, they reported having administered home-made ‘alkaline lemonade’, without being able to specify the amount of baking soda, but bigger than the recommended ‘point of knife’ quantity. Therefore, the ‘alkaline lemonade’ poisoning along with the dehydration caused by AGE, explain the magnitude of ionic and acid-base disorders.

Conclusions:

‘Alkaline lemonade’ recipe is not very accurate, which can lead to elaboration mistakes, as our patient´s case.

In conclusion, we should recommend oral rehydration solutions for AGE management and inform appropriately about their alternatives.