32:
497:
To effectively treat metabolic alkalosis, the underlying cause(s) must be corrected. A trial of intravenous chloride-rich fluid is warranted if there is a high index of suspicion for chloride-responsive metabolic alkalosis caused by loss of gastrointestinal fluid (e.g., due to vomiting).
221:
subsequently stimulates reabsorption of sodium (and thus water) within the nephron of the kidney. However, a second action of aldosterone is to stimulate renal excretion of hydrogen ions (while retaining bicarbonate), and it is this loss of hydrogen ions that raises the pH of the blood.
253:), which results in respiratory acidosis. Renal compensation with excess bicarbonate retention occurs to lessen the effect of the acidosis. Once carbon dioxide levels return to base line, the higher bicarbonate levels reveal themselves putting the patient into metabolic alkalosis.
236:
can both initially cause increase in chloride, but once stores are depleted, urine excretion will be below < 25 mEq/L. The loss of fluid from sodium excretion causes a contraction alkalosis. Diuretic abuse among athletes and people with
440:
intermediate, thus decreasing pH. Respiratory compensation, though, is incomplete. The decrease in suppresses the peripheral chemoreceptors, which are sensitive to pH. But, because respiration slows, there is an increase in
195:). The kidneys compensate for these losses by retaining sodium in the collecting ducts at the expense of hydrogen ions (sparing sodium/potassium pumps to prevent further loss of potassium), leading to metabolic alkalosis.
406:
toxicity can induce a hypokalemic metabolic alkalosis via activating the calcium sensing receptor in the thick ascending limb of the nephron, inactivating the NKCC2 cotransporter, creating a
Bartter's syndrome like
846:
831:
290:
Blood product administration since this contains sodium citrate which is then metabolized into sodium bicarbonate. Typically, this is seen with large volume transfusions such as more than 8 units.
322:. Due to a low extracellular potassium concentration, potassium shifts out of the cells. In order to maintain electrical neutrality, hydrogen shifts into the cells, raising blood pH.
396:
390:
261:– excessive loss of sodium chloride in the sweat leads to contraction of the extracellular volume in the same way as contraction alkalosis, as well chloride depletion.
336:) increases the activity of a sodium-hydrogen exchange protein in the kidney. This increases the retention of sodium ions whilst pumping hydrogen ions into the
647:"The abuse of diuretics as performance-enhancing drugs and masking agents in sport doping: pharmacology, toxicology and analysis: Diuretics in sport doping"
694:
Mascolo, Margherita; Chu, Eugene S.; Mehler, Philip S. (April 2011). "Abuse and clinical value of diuretics in eating disorders therapeutic applications".
386:– a gain of function mutation in the genes encoding the epithelial sodium channel (ENaC) which is characterized by hypertension and hypoaldosteronism.
789:
Cho Kerry C, "Chapter 21. Electrolyte & Acid-Base
Disorders" (Chapter). McPhee SJ, Papadakis MA: CURRENT Medical Diagnosis & Treatment 2011:
448:
which would cause an offset of the depression because of the action of the central chemoreceptors which are sensitive to the partial pressure of CO
340:. Excess sodium increases extracellular volume and the loss of hydrogen ions creates a metabolic alkalosis. Later, the kidney responds through the
924:
184:(hydrogen and chloride ions) with the stomach contents. In the hospital setting this can commonly occur from nasogastric suction tubes.
213:– This results from a loss of water in the extracellular space, such as from dehydration. Decreased extracellular volume triggers the
802:
Hasan, Ashfaq. "The
Analysis of Blood Gases." Handbook of Blood Gas/Acid-Base Interpretation. Springer London, 2013. pp. 253–266.
102:), or alternatively a direct result of increased bicarbonate concentrations. The condition typically cannot last long if the
598:"Congenital Chloride Diarrhea: Accurate Prenatal Diagnosis Using Color Doppler Sonography to Show the Passage of Diarrhea"
1091:
1065:
554:
958:
917:
452:
in the cerebral spinal fluid. So, because of the central chemoreceptors, respiration rate would be increased.
458:
for metabolic alkalosis, less effective than respiratory compensation, consists of increased excretion of HCO
910:
214:
201:
581:
734:"Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent"
1070:
985:
378:– syndromes with presentations analogous to taking diuretics characterized with normotensive patients
79:
429:
118:
often cause no symptoms. Typical manifestations of moderate to severe metabolic alkalosis include
990:
995:
973:
933:
645:
Cadwallader, Amy B; De La Torre, Xavier; Tieri, Alessandra; Botrè, Francesco (September 2010).
1049:
1042:
968:
541:
209:
1015:
1007:
536:
285:
158:
The causes of metabolic alkalosis can be divided into two categories, depending upon urine
8:
850:
314:
249:– Hypoventilation (decreased respiratory rate) causes hypercapnia (increased levels of CO
562:"Alkalosis, Metabolic: eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine"
561:
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790:
671:
646:
531:
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341:
333:
67:
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627:
619:
374:
181:
46:
39:
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745:
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666:
658:
609:
368:
75:
978:
425:
382:
257:
238:
417:
403:
356:
229:
840:
416:
Compensation for metabolic alkalosis occurs mainly in the lungs, which retain
1085:
866:
759:
623:
437:
362:
51:
963:
715:
680:
631:
614:
597:
349:
337:
272:
268:
192:
174:– Most often occurs via two mechanisms, either vomiting or via the kidney.
119:
83:
767:
473:
in the setting of metabolic alkalosis, the following equations are used:
526:
329:
319:
305:
218:
188:
135:
131:
87:
823:
750:
733:
127:
55:
902:
707:
516:
refers to a pH which is higher than normal, specifically in the blood.
205:– rare for being a diarrhea that causes alkalosis instead of acidosis.
1029:
885:
233:
165:
115:
596:
Hirakawa, M.; Hidaka, N.; Kido, S.; Fukushima, K.; Kato, K. (2015).
297:
941:
177:
159:
147:
31:
293:
Decreases in albumin and phosphate will cause metabolic alkalosis.
267:– Alkalotic agents, such as bicarbonate (administered in cases of
143:
644:
835:
275:) or antacids, administered in excess can lead to an alkalosis.
123:
103:
595:
442:
139:
466:
exceeds the ability of the renal tubule to reabsorb it.
328:– Loss of hydrogen ions in the urine occurs when excess
780:
Miller's
Anesthesia, 8th Edition, Chapter 60, 1811–1829
71:
16:
Abnormally high tissue pH due to metabolic dysfunction
813:
791:
http://www.accessmedicine.com/content.aspx?aID=10909
309:– Retention of bicarbonate would lead to alkalosis.
279:
732:Bates, C. M.; Baum, M.; Quigley, R. (1997-02-01).
166:Chloride-responsive (Urine chloride < 25 mEq/L)
589:
510:refers to a process by which the pH is increased.
298:Chloride-resistant (Urine chloride > 20 mEq/L)
1083:
731:
693:
586:. Churchill Livingstone 1 edition (18 Sep 2007).
187:Severe vomiting also causes loss of potassium (
918:
738:Journal of the American Society of Nephrology
436:is then consumed toward the formation of the
82:(7.35–7.45). This is the result of decreased
925:
911:
462:(bicarbonate), as the filtered load of HCO
30:
749:
696:International Journal of Eating Disorders
670:
613:
344:to excrete sodium and chloride in urine.
932:
1084:
906:
241:may present with metabolic alkalosis.
148:temporary waxing and waning confusion
109:
727:
725:
400:– both characterized by hypertension
357:Low levels of magnesium in the blood
215:renin-angiotensin-aldosterone system
136:low levels of potassium in the blood
86:concentration, leading to increased
1066:Mixed disorder of acid-base balance
363:high levels of calcium in the blood
13:
14:
1103:
809:
722:
602:Journal of Ultrasound in Medicine
663:10.1111/j.1476-5381.2010.00789.x
280:Chloride-indeterminate alkalosis
651:British Journal of Pharmacology
424:) through slower breathing, or
411:
796:
783:
774:
687:
638:
583:Arterial Blood Gases Made Easy
574:
501:
122:, neuromuscular irritability,
1:
547:
469:To calculate the expected pCO
130:(usually due to accompanying
580:Hennessey, Iain. Japp, Alan.
492:
313:Shift of hydrogen ions into
202:Congenital chloride diarrhea
7:
520:
10:
1108:
397:17α-hydroxylase deficiency
391:11β-hydroxylase deficiency
106:are functioning properly.
1058:
1028:
1006:
949:
940:
876:
817:
153:
45:
38:
29:
24:
430:respiratory compensation
114:Mild cases of metabolic
180:results in the loss of
78:is elevated beyond the
1092:Acid–base disturbances
974:Alcoholic ketoacidosis
615:10.7863/ultra.15.01011
134:abnormalities such as
128:abnormal heart rhythms
1071:Acid–base homeostasis
1043:Contraction alkalosis
969:Diabetic ketoacidosis
542:Respiratory alkalosis
210:Contraction alkalosis
172:Loss of hydrogen ions
537:Respiratory acidosis
481:= 0.7 + 20 mmHg ± 5
286:Milk alkali syndrome
934:Acid–base disorders
315:intracellular space
120:abnormal sensations
64:Metabolic alkalosis
25:Metabolic alkalosis
877:External resources
751:10.1681/ASN.V82352
532:Metabolic acidosis
456:Renal compensation
342:aldosterone escape
326:Hyperaldosteronism
110:Signs and symptoms
68:acid-base disorder
1079:
1078:
1024:
1023:
900:
899:
708:10.1002/eat.20814
608:(11): 2113–2115.
375:Gitelman syndrome
182:hydrochloric acid
61:
60:
40:Davenport diagram
19:Medical condition
1099:
986:Normal anion gap
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488:= 0.7 + 21 mmHg
369:Bartter syndrome
265:Alkalotic agents
239:eating disorders
226:Diuretic therapy
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426:hypoventilation
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383:Liddle syndrome
334:Conn's syndrome
300:
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258:Cystic fibrosis
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247:Posthypercapnia
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156:
112:
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991:Hyperchloremic
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959:High anion gap
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818:Classification
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810:External links
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744:(2): 352–355.
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702:(3): 200–202.
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418:carbon dioxide
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404:Aminoglycoside
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230:loop diuretics
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191:) and sodium (
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438:carbonic acid
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304:Retention of
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70:in which the
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65:
57:
53:
52:Endocrinology
50:
48:
44:
41:
37:
33:
28:
23:
1037:
964:Ketoacidosis
884:
860:
845:
830:
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776:
741:
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689:
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565:. Retrieved
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513:
507:
496:
468:
454:
415:
412:Compensation
395:
389:
381:
373:
367:
350:glycyrrhizin
347:
338:renal tubule
325:
312:
303:
273:hyperacidity
269:peptic ulcer
264:
256:
246:
225:
208:
200:
193:hyponatremia
171:
157:
113:
84:hydrogen ion
80:normal range
63:
62:
1050:Respiratory
1016:Respiratory
1008:Respiratory
657:(1): 1–16.
527:Hypokalemia
502:Terminology
352:consumption
330:aldosterone
320:hypokalemia
306:bicarbonate
219:aldosterone
189:hypokalemia
132:electrolyte
88:bicarbonate
862:DiseasesDB
567:2009-05-10
548:References
318:– Seen in
56:nephrology
1038:Metabolic
1030:Alkalosis
951:Metabolic
886:eMedicine
760:1046-6673
624:0278-4297
514:Alkalemia
508:Alkalosis
493:Treatment
361:Severely
234:thiazides
116:alkalosis
47:Specialty
1086:Category
942:Acidosis
891:med/1459
716:20186716
681:20718736
632:26446821
521:See also
178:Vomiting
162:levels.
160:chloride
144:seizures
768:9048354
672:2962812
407:effect.
348:Excess
104:kidneys
979:Lactic
766:
758:
714:
679:
669:
630:
622:
217:, and
154:Causes
146:, and
124:tetany
76:tissue
66:is an
1059:Other
856:276.3
841:E87.3
432:). CO
851:9-CM
764:PMID
756:ISSN
712:PMID
677:PMID
628:PMID
620:ISSN
394:and
372:and
232:and
140:coma
867:402
847:ICD
832:ICD
746:doi
704:doi
667:PMC
659:doi
655:161
610:doi
484:pCO
477:pCO
443:pCO
420:(CO
271:or
138:),
92:HCO
74:of
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889::
865::
854::
839::
836:10
762:.
754:.
740:.
736:.
724:^
710:.
700:44
698:.
675:.
665:.
653:.
649:.
626:.
618:.
606:34
604:.
600:.
228:–
150:.
142:,
126:,
72:pH
54:,
926:e
919:t
912:v
849:-
834:-
824:D
793:.
770:.
748::
742:8
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661::
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486:2
479:2
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428:(
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332:(
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95:−
90:(
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