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Baking Soda Pica: A Case of Hypokalemic Metabolic Alkalosis and Rhabdomyolysis in Pregnancy

Grotegut, Chad A. MD1; Dandolu, Vani MD1; Katari, Sunita MD1; Whiteman, Valerie E. MD1; Geifman-Holtzman, Ossie MD1; Teitelman, Melissa MD2

doi: 10.1097/01.AOG.0000167391.61168.e2
Case Report
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BACKGROUND: We report a case of baking soda pica in a woman at 31 weeks of pregnancy causing severe hypokalemic metabolic alkalosis and rhabdomyolysis.

CASE: A multigravida at 31 weeks of gestation presented with weakness and muscle pain. She was found to have severe hypokalemic metabolic alkalosis and rhabdomyolysis, with elevation in serum transaminases and hypertension. We initially thought the patient had an atypical presentation of preeclampsia until it was realized that she was ingesting 1 full box of baking soda (454 g sodium bicarbonate) per day. Symptoms and abnormal laboratory findings resolved with discontinuation of the patient’s pica practices.

CONCLUSION: Pica is a common but often overlooked practice that can potentially lead to life-threatening disorders. A thorough evaluation of a patient’s dietary intake is extremely important, especially in the setting of atypical presentations of disease in pregnancy.

A pregnancy was complicated by hypokalemic metabolic alkalosis and rhabdomyolysis secondary to baking soda pica.

From the Department of Obstetrics and Gynecology, Temple University School of Medicine, Philadelphia, Pennsylvania; and 2Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

Corresponding author: Chad A. Grotegut, MD, Assistant Professor, Temple University Hospital, 3401 North Broad Street, 7th Floor OPB, Philadelphia, PA 19140; e-mail: grotegca@tuhs.temple.edu or grotegutc@yahoo.com.

© 2006 The American College of Obstetricians and Gynecologists