II. Indications
-
Metabolic Alkalosis evaluation
- Differentiates Chloride Depletion Metabolic Alkalosis from non-chloride depletion
III. Interpretation: Normal
- Urine Chloride >20 mEq/L (>20 mmol/L)
- Urine Chloride: 110-250 mEq per 24 hours
IV. Causes: Decreased Urine Chloride <20 mEq/L (Chloride Depletion Metabolic Alkalosis)
- Gastrointestinal causes
- Renal Causes
- Diuretic use
- Urine Chloride >10 meq/L and may vary considerably (including >20 mEq/L)
- Poorly reabsorbable anion
- Carbenicillin
- Penicillin
- Sulfate
- Phsophate
- Post-Hypercapnia
- Diuretic use
- Exogenous alkali
- Sodium Bicarbonate (Baking Soda)
- Sodium Citrate
- Lactate
- Gluconate
- Acetate
- Transfusion
- Antacid
- Other causes
- Cystic Fibrosis
- Achlorhydria
- Contraction alkalosis (Dehydration)
V. Causes: Urine Chloride >20 mEq/L (Non-Chloride Depletion Metabolic Alkalosis)
- 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
- Adrenal Disease
- Normotensive Patient
- Bartter Syndrome or Gitelman Syndrome
- Hypokalemia
- Excessive alkali administration
- Milk-Alkali Syndrome
- Refeeding alkalosis
- Overcompensation for chronic Respiratory Acidosis (esp. chronic COPD with hypercapnia)
- Excessive Mechanical Ventilation (excess bicarbonate is typically slow to correct)