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Metabolic Alkalosis
Aka: Metabolic Alkalosis
- See Also
- Arterial Blood Gas
- ABG Interpretation
- Types
- Chloride responsive Metabolic Alkalosis
- Extracellular fluid contraction
- Saline responsive
- Chloride-resistant Metabolic Alkalosis
- Associated with excess mineralocorticoid
- Associated with Hypokalemia
- Saline unresponsive
- Causes: Low Urine Chloride <10 meq/L
- Gastrointestinal causes
- Vomiting
- Nasogastric suction
- Chloride-wasting Diarrhea
- Villous adenoma of colon
- Renal Causes
- Diuretic use (Urine Chloride >10 meq/L)
- Poorly reabsorbable anion
- Carbenicillin
- Penicillin
- Sulfate
- Phsophate
- Post-Hypercapnia
- Exogenous alkali
- Sodium Bicarbonate (baking soda)
- Sodium Citrate
- Lactate
- Gluconate
- Acetate
- Transfusion
- Antacid
- Cystic Fibrosis
- Achlorhydria
- Contraction alkalosis
- Causes: Normal or High Urine Chloride >20 meq/L
- Hypertensive Patient
- Adrenal Disease
- Primary Hyperaldosteronism
- Cushing's Syndrome (Pituitary, Adrenal or ectopic)
- Liddle Syndrome
- Exogenous steroids
- Excess mineralocorticoid intake
- Excess glucocorticoid intake
- Excessive licorice intake
- Carbenoxalone
- Glycyrrhizic acid
- Chewing Tobacco
- Normotensive Patient
- Bartter Syndrome or Gitelman Syndrome
- Hypokalemia
- Excessive alkali administration
- Milk-Alkali Syndrome
- Refeeding alkalosis
- Labs
- Arterial Blood Gas
- Arterial pH increased
- Serum bicarbonate increased
- PaCO2 increased
- PaCO2 rises 6 mmHg per 10 meq/L bicarbonate rise
- PaCO2 = 0.7 x HCO3 + 20 (+/- 1.5)
- Excess Anion Gap >30 mEq/L
- Urine Chloride
- See Above
- References
- Arieff (1993) J Crit Illn 8(2): 224-46 [PubMed]
- Narins (1982) Am J Med 72:496 [PubMed]
- Narins (1980) Medicine 59:161-95 [PubMed]
- Ghosh (2000) Fed Pract p. 23-33
- Rutecki (Dec 1997) Consultant, p. 3067-74
- Rutecki (Jan 1998) Consultant, p. 131-42