Pancreatic Mass and Metabolic Alkalosis

Framework for a Solitary Pancreatic MassPicture1

Metabolic Alkalosis!!

  • Please see the previously posted pearls on metabolic alkalosis: https://ucsfmed.wordpress.com/2016/06/27/moffitt-am-report-pearls-62716-acid-base-disorders-and-metabolic-alkalosis/
  • Key points: – Think about losses of H+ (GI or renal), transcellular shift of H+, contraction alkalosis, and too much bicarb intake! – Useful test to send: Urine Chloride!
    • Urine Cl < 25: saline responsive! Given volume to these patients : Examples include vomiting, diuretic use, contraction alkalosis
    • Urine Cl > 40: saline unresponsive
      : Examples include renal losses, electrolyte derangements
      : If patient is saline unresponsive, look at their BP
      –> Low/normal P: severe hypokalemia, Bartter’s
      –> elevated BP: hyperaldosteronism, hypercortisolism


Use of CA 19-9 in Treatment of Pancreatic Adenocarcinoma

  • There is a correlation between duration of patient survival and decline in level of CA 19-9 in patients receiving chemotherapy. However, there is much debate on the reliability of using CA 19-9 as a surrogate for survival.
  • ASCO (American Society of Clinical Oncology): “data is insufficient” to use serum 19-9 levels alone for monitoring response to treatment> : Recommendation is to measure CA 19-9 levels at start of treatment and then every 1-3 months during therapy for advanced pancreatic cancer. Suspected disease progression based upon rising CA 19-9 levels should be confirmed radiographically!
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