A 40-year-old man develops repeated bilious vomiting 12 hours after onset of high jejunal obstruction from adhesions. Which pattern of fluid and electrolyte disturbance is expected early in his course?

• A Hyperchloremic metabolic acidosis with hypokalemia
• B Normal chloride with respiratory alkalosis
• C Hypochloremic hypokalemic metabolic alkalosis ✓
• D Hyperkalemia with metabolic acidosis

Explanation

Proximal small bowel losses are rich in hydrogen ion and chloride, so repeated vomiting of gastric and upper jejunal contents produces hypochloremic, hypokalemic metabolic alkalosis, compounded by potassium shift into cells and renal potassium wasting driven by aldosterone from volume depletion. Distal obstruction, where more of the loss comes as stagnant luminal fluid, tends toward dehydration with less pronounced alkalosis. Acidosis would suggest strangulation with sepsis or advanced ischemia, not early simple obstruction.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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