II. Types

  1. Chloride responsive Metabolic Alkalosis
    1. Extracellular fluid contraction
    2. Saline responsive
  2. Chloride-resistant Metabolic Alkalosis
    1. Associated with excess mineralocorticoid
    2. Associated with Hypokalemia
    3. Saline unresponsive

III. Causes: Low Urine Chloride <10 meq/L

  1. Gastrointestinal causes
    1. Vomiting
    2. Nasogastric suction
    3. Chloride-wasting Diarrhea
    4. Villous adenoma of colon
  2. Renal Causes
    1. Diuretic use (Urine Chloride >10 meq/L)
    2. Poorly reabsorbable anion
      1. Carbenicillin
      2. Penicillin
      3. Sulfate
      4. Phsophate
    3. Post-Hypercapnia
  3. Exogenous alkali
    1. Sodium Bicarbonate (baking soda)
    2. Sodium Citrate
    3. Lactate
    4. Gluconate
    5. Acetate
    6. Transfusion
    7. Antacid
  4. Cystic Fibrosis
  5. Achlorhydria
  6. Contraction alkalosis

IV. Causes: Normal or High Urine Chloride >20 meq/L

  1. Hypertensive Patient
    1. Adrenal Disease
      1. Primary Hyperaldosteronism
      2. Cushing's Syndrome (Pituitary, Adrenal or ectopic)
      3. Liddle Syndrome
    2. Exogenous steroids
      1. Excess mineralocorticoid intake
      2. Excess glucocorticoid intake
      3. Excessive licorice intake
      4. Carbenoxalone
      5. Glycyrrhizic acid
      6. Chewing Tobacco
  2. Normotensive Patient
    1. Bartter Syndrome or Gitelman Syndrome
    2. Hypokalemia
    3. Excessive alkali administration
    4. Milk-Alkali Syndrome
    5. Refeeding alkalosis

V. Labs

  1. Arterial Blood Gas
    1. Arterial pH increased
    2. Serum bicarbonate increased
    3. PaCO2 increased
      1. PaCO2 rises 6 mmHg per 10 meq/L bicarbonate rise
      2. PaCO2 = 0.7 x HCO3 + 20 (+/- 1.5)
    4. Excess Anion Gap >30 mEq/L
  2. Urine Chloride
    1. See Above

VI. References

  1. Arieff (1993) J Crit Illn 8(2): 224-46 [PubMed]
  2. Narins (1982) Am J Med 72:496 [PubMed]
  3. Narins (1980) Medicine 59:161-95 [PubMed]
  4. Ghosh (2000) Fed Pract p. 23-33
  5. Rutecki (Dec 1997) Consultant, p. 3067-74
  6. Rutecki (Jan 1998) Consultant, p. 131-42

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Ontology: Metabolic alkalosis (C0220983)

Definition (NCI) Abnormally increased pH levels in the blood due to excessive loss of acid and/or accumulation of base.
Concepts Disease or Syndrome (T047)
ICD10 E87.3
SnomedCT 1388004
English ALKALOSIS METABOLIC, metabolic alkalosis, metabolic alkalosis (diagnosis), Alkalosis metabolic, Metabolic alkaloses, metabolic alkaloses, alkalosis metabolic, disorder metabolic alkalosis, Metabolic Alkalosis, Metabolic alkalosis, Metabolic alkalosis (disorder)
Italian Alcalosi metabolica, Alcalosi metaboliche
German Alkalose metabolisch, ALKALOSE METABOLISCH, Metabolische Alkalosen, metabolische Alkalose
Japanese 代謝性アルカローシス, タイシャセイアルカローシス
Portuguese ALCALOSE METABOLICA, Alcalose metabólica, Alcaloses metabólicas
French ALCALOSE METABOLIQUE, Alcalose métabolique, Alcaloses métaboliques
Spanish ALCALOSIS METABOLICA, alcalosis metabólica (trastorno), alcalosis metabólica, Alcalosis metabólicas, Alcalosis metabólica
Czech Metabolické alkalózy, Metabolická alkalóza
Hungarian Anyagcsere alkalosisok, Metabolikus alkalosis, Metabolicus alkalosis
Dutch metabole alkalosen, metabole alkalose