摘要Background:We present an atypical case of severe metabolic alkalosis,not reported in the literature to date.Case Presentation:Owing to concerns of apneas and desaturation,a 75-year-old man presented to the emergency department with significantly deranged physiology:bicarbonate level of 63.6 mmol/L,a base excess of 40.6,and a potassium concentration of 1.9 mmol/L.Primary diagnoses included metabolic alkalosis secondary to fludrocortisone therapy with respiratory compensation,hypokalemia,and hypochloremia.He initially.received potassium replacement with cardiac monitoring,followed by permissive hypercapnia in the intensive care unit.He received acetazolamide to further improve his acid-base status.The patient hada good outcome with gradual return of his pH and bicarbonate levels to.baseline.He was then discharged.Conclusion:latrogenic mineralocorticoid excess should be considered when the patient presents with significantly raised bicarbonate levels.When starting fludrocortisone,renal function needs to be diligently monitored due to risk of hypokalemia metabolic alkalosis.