Hyperchloremic metabolic acidosis following plasma exchange during myasthenia gravis crisis

Background: Therapeutic plasma exchanges are increasingly used, notably during myasthenia gravis crisis. Repeated exchanges may induce severe adverse events. Case: We reported a case of symptomatic hyperchloremic metabolic acidosis following a therapeutic plasma exchange. Analysis of 4% albumin substitution solution revealed a chloride concentration of 145 mmol/L, which could explain this acidosis. Discussion: Infusion of high volume of 4% albumin during plasma exchanges may produce hyerchloremic metabolic acidosis. Conclusion: Special attention should be paid when repeated plasma exchanges are performed. J. Clin. Apheresis 31:479–480, 2016. © 2015 Wiley Periodicals, Inc.