The McKittrick-Wheelock Syndrome: A Case of Acute Renal Failure Due to Neoplastic Cholera

Abstract

The McKittrick Wheelock syndrome is characterized by severe electrolyte and fluid depletion as a result of rectal tumor hypersecretion. Typically, a metabolic acidosis ensues. We report the case of a 58-year-old man who presented with a mixed metabolic acidosis and alkalosis. He was hyponatremic, hypokalemic, and hypochloremic, with acute renal failure on blood testing. Following fluid resuscitation, a predominant alkalemia was observed. The patient was found to be passing 1.5 L of mucous per rectum per day, containing high concentrations of sodium and potassium, similar to that observed in cholera stool. A large rectal villous adenoma was discovered on sigmoidoscopy, and definitive management was achieved by removal of the tumor. This case provides a demonstration of the ranging metabolic disturbance associated with secretory diarrhea. Other endogenous and infective causes are discussed, and mechanisms compared with the case described.

Indomethacin therapy effective in a patient with depletion syndrome from secretory villous adenoma

“…Commonly, a patient will present with diarrhoea as some part of their history, but that diarrhoea may be chronic in nature occurring over 10–15 years,10 11 whereas others have a more recent onset of diarrhoea. The description of diarrhoea may change from patient to patient, with some reporting profuse diarrhoea of more than 10 loose, watery bowel movements per day, while others describe a rectal mucous discharge,12 or clear mucus stools,13 instead of using the word ‘diarrhoea’. Additionally, patients may present with signs of intestinal obstruction or pseudo-obstruction rather than diarrhoeal illness 14 15.…”

“…Other presentations seen in the literature include:14 16 acute kidney injury, syncope, hypovolaemic shock, weakness, dermatomyositis, rectal prolapse or rectal intussusception. Regardless of the initial presentation, all patients exhibit massive fluid losses, up to 1.5–3.5 L per day, and the losses will increase as the adenoma grows 12 17. The secreted fluid is rich in sodium, potassium and chloride depleting these electrolytes in a very acute and severe manner.…”

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

“…Generally, diarrhea causes metabolic acidosis without an increased anion gap due to loss of potassium and bicarbonate from the colon. However, the pH range of McKittrick-Wheelock syndrome is wide, ranging from metabolic [2,3] and respiratory alkalosis [4,5] to metabolic acidosis [6][7][8]. Severe electrolyte depletion from diarrhea produces several secondary complications, including hyperventilation and renal failure.…”

Episodic electrolyte disorders and renal failure due to a rare disease: the McKittrick-Wheelock syndrome

“…In the McKittrick–Wheelock syndrome, a large rectal or sigmoid villous adenoma causes secretory diarrhoea with marked electrolyte and acid–base disturbances and dehydration as a consequence [ 6 ]. Several mechanisms can explain the electrolyte disturbances and dehydration in this syndrome.…”