Yan Chu, MD1, Leen Al-Sayyed, MD1, Katie Schroeder, MD2 1St. Louis University, St. Louis, MO; 2St. Louis University Hospital, St. Louis, MO
Introduction: Baking powder consists of baking soda (sodium bicarbonate) and acid salts. Baking powder and soda are common household products used in home remedies for symptoms such as dyspepsia and aphthous ulcers. Nevertheless, limited documentation of their toxicities exist. We present a case of diarrhea and severe metabolic derangements secondary to baking powder ingestion.
Case Description/Methods: A 28-year-old previously healthy female presented with headache. She was hypertensive (201/108 mmHg). Labs were notable for Hgb 6.7 g/dL (11.5 g/dL 2 years ago), MCV 65.1 fL, K 1.9 mmol/L, Cl 93 mmol/L, CO2 38 mmol/L, Mg 2.3 mg/dL and urine pH 9.0. EKG and CT head were normal. CT abdomen showed liquid stool throughout colon and rectum without bowel wall thickening. She later revealed that she had been having 3-5 brown watery stools daily since her last pregnancy 3 years ago. She had occasional abdominal cramps without nocturnal diarrhea, steatorrhea, hematochezia, melena or recent travels. During her pregnancy, she developed a craving for baking powder and had been ingesting 2-3 spoonful daily since. Diarrhea workup showed normal TSH, negative CRP and TTG-IgA. Stool studies were incomplete as her diarrhea slowed. Anemia workup showed profound iron deficiency anemia. She received IV iron and blood products, and Hgb improved appropriately. Metabolic disturbances gradually normalized with IV fluids and KCl. Hypertension improved with antihypertensives and headache resolved. She was discharged on PO iron.
Discussion: The temporal relationship of baking powder ingestion to patient presentation and rapid improvement after toxin cessation strongly supports a rare case of baking powder-induced diarrhea with metabolic derangements. Normally kidneys are capable of excreting alkali, but excessive bicarbonate ingestion can cause metabolic alkalosis even in patients with normal renal function. Derangements reported in literature include hypernatremia, hypokalemia, hypochloremia, hypocalcemia and urinary alkalinization. This patient’s symptoms of hypertension, headache and diarrhea were also attributed to baking powder ingestion, which in turn, was suspected to be pica in the setting of iron deficiency. Most mild cases of ingestion resolve with supportive care and cessation of the offending agent. This case illustrates the potential adverse effects of ingesting a common household item. Recognition of baking powder and soda toxicity is critical to institution of appropriate treatment and prevention by patient education.
Disclosures: Yan Chu indicated no relevant financial relationships. Leen Al-Sayyed indicated no relevant financial relationships. Katie Schroeder indicated no relevant financial relationships.
Yan Chu, MD1, Leen Al-Sayyed, MD1, Katie Schroeder, MD2. P1272 - A Curious Case of Baking Powder, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
