Metabolic alkalosis - Revision history

Danbot: Add evidence-based Disposition section

2026-03-22T10:03:53Z

Add evidence-based Disposition section

← Revisión anterior		Revisión del 10:03 22 mar 2026
Línea 71:		Línea 71:
	*Note: if patient is edematous (CHF, cirrhosis), do NOT give normal saline		*Note: if patient is edematous (CHF, cirrhosis), do NOT give normal saline
	**If patient is hypokalemic, KCl will correct both hypoK AND alkalosis		**If patient is hypokalemic, KCl will correct both hypoK AND alkalosis

			==Disposition==
			*Admit for:
			**Severe alkalosis (pH >7.55) - risk of arrhythmias and seizures
			**Symptomatic patients (confusion, tetany, arrhythmia)
			**Underlying cause requiring inpatient management (GI losses, diuretic excess)
			*Discharge with close follow-up for:
			**Mild alkalosis (pH 7.45-7.50) with identified correctable cause
			**Asymptomatic patients with stable vitals

	==See Also==		==See Also==

ClaireLewis: /* Chloride-resistant */

2019-09-22T18:05:40Z

Chloride-resistant

← Revisión anterior		Revisión del 18:05 22 sep 2019
Línea 35:		Línea 35:
	*Intravenous [[penicillin]]		*Intravenous [[penicillin]]
	*[[Refeeding syndrome\|Refeeding alkalosis]]		*[[Refeeding syndrome\|Refeeding alkalosis]]
	*[[Massive blood transfusion]]		*[[Massive transfusion\|Massive blood transfusion]]
	*Primary hyperaldosteronism		*Primary hyperaldosteronism
	*[[CAH]] (11-Hydroxylase or 17-hydroxylase deficiency)		*[[CAH]] (11-Hydroxylase or 17-hydroxylase deficiency)

ClaireLewis: /* Background */

2019-09-22T18:05:07Z

Background

← Revisión anterior		Revisión del 18:05 22 sep 2019
Línea 6:		Línea 6:
	*Shift of hydrogen ions intracellularly (from [[hypokalemia]])		*Shift of hydrogen ions intracellularly (from [[hypokalemia]])
	*Bicarbonate administration		*Bicarbonate administration
	*Contraction alkalosis ([[Diuretic]] administration, [[diarrhea]], or any excessive [[~~hypervolemia~~\|loss of volume]])		*Contraction alkalosis ([[Diuretic]] administration, [[diarrhea]], or any excessive [[hypovolemia\|loss of volume]])

	==Clinical Features==		==Clinical Features==

ClaireLewis at 18:04, 22 September 2019

2019-09-22T18:04:53Z

← Revisión anterior		Revisión del 18:04 22 sep 2019
Línea 3:		Línea 3:

	===Main Causes===		===Main Causes===
	*Hydrogen ion loss (via vomiting)		*Hydrogen ion loss (via [[vomiting]])
	*Shift of hydrogen ions intracellularly (from hypokalemia)		*Shift of hydrogen ions intracellularly (from [[hypokalemia]])
	*Bicarbonate administration		*Bicarbonate administration
	*Contraction alkalosis (Diuretic administration, diarrhea, or any excessive loss of volume)		*Contraction alkalosis ([[Diuretic]] administration, [[diarrhea]], or any excessive [[hypervolemia\|loss of volume]])

	==Clinical Features==		==Clinical Features==
	Symptoms are ~~non specific~~ and usually result from the concomitant [[hypokalemia]] or [[hypocalcemia]]. Common signs and symptoms include		Symptoms are nonspecific and usually result from the concomitant [[hypokalemia]] or [[hypocalcemia]]. Common signs and symptoms include
	*Weakness/Fatigue		*[[Weakness]]/Fatigue
	*Vomiting or diarrhea		*[[Vomiting]] or [[diarrhea]]
	*Hypoventilation		*Hypoventilation

Línea 20:		Línea 20:
	#*[[Vomiting]]		#*[[Vomiting]]
	#*NG suction		#*NG suction
	#*[[~~Bulemia~~]]		#*[[Bulimia nervosa\|Bulimia]]
	#Loss of colonic secretions		#Loss of colonic secretions
	#*[[Diarrhea]]		#*[[Diarrhea]]
	#*Congenital chloridorrhea		#*Congenital chloridorrhea
	#*Villous adenoma		#*Villous adenoma
	#Thiazides/loop diuretics		#Thiazides/loop [[diuretics]]
	#Cystic fibrosis		#[[Cystic fibrosis]]
	===Chloride-resistant===		===Chloride-resistant===
	'''Urine Cl > 20 mEq/L'''		'''Urine Cl > 20 mEq/L'''
	*Exogenous alkali (Nabicarb + renal failure, metabolism of lactic acid, or ketoacids)		*Exogenous alkali (Nabicarb + [[renal failure]], metabolism of lactic acid, or ketoacids)
	**Potassium acetate		**Potassium acetate
	*[[Milk alkali syndrome]]		*[[Milk alkali syndrome]]
	*[[Hypercalcemia]] (inability to concentrate urine leads to hypovolemia)		*[[Hypercalcemia]] (inability to concentrate urine leads to hypovolemia)
	*Intravenous [[penicillin]]		*Intravenous [[penicillin]]
	*Refeeding alkalosis		*[[Refeeding syndrome\|Refeeding alkalosis]]
	*[[Massive blood transfusion]]		*[[Massive blood transfusion]]
	*Primary hyperaldosteronism		*Primary hyperaldosteronism
	*CAH (11-Hydroxylase or 17-hydroxylase deficiency)		*[[CAH]] (11-Hydroxylase or 17-hydroxylase deficiency)
	*[[Cushing syndrome]]		*[[Cushing syndrome]]
	*Exogenous steroids		*Exogenous [[steroids]]
	*Liddle syndrome		*Liddle syndrome
	*Renovascular hypertension		*Renovascular hypertension
	*Bartter syndrome (pediatrics)		*Bartter syndrome (pediatrics)
	*Gitelman syndrome (pediatrics)		*Gitelman syndrome (pediatrics)
	*Severe K+ depletion		*Severe [[Hypokalemia\|K+ depletion]]
	*[[Hypomagnesemia]]		*[[Hypomagnesemia]]

Línea 58:		Línea 58:
	==Management==		==Management==
	#Correct volume depletion		#Correct volume depletion
	#*Normal ~~Saline~~		#*[[Normal saline]]
	#**Repletion of extracellular volume decreased need for Na reaborption		#**Repletion of extracellular volume decreased need for Na reaborption
	#**Delivery of Cl to distal tubule increases Cl/bicarb exchange		#**Delivery of Cl to distal tubule increases Cl/bicarb exchange
	#Correct potassium depletion		#Correct [[potassium]] depletion
	#*Giving K+ leads to movement of H+ out of cells → acidosis		#*Giving K+ leads to movement of H+ out of cells → acidosis
	#*Giving K+ stops hypokalemia-induced distal H+/K+ pump		#*Giving K+ stops hypokalemia-induced distal H+/K+ pump
Línea 67:		Línea 67:
	#*Must give a reabsorbable anion to replace HCO3		#*Must give a reabsorbable anion to replace HCO3
	#Correct mineralocorticoid excess		#Correct mineralocorticoid excess
	#*~~Aldostorone~~ antagonists if indicated (i.e. spironolactone)		#*Aldosterone antagonists if indicated (i.e. [[spironolactone]])

	*Note: if patient is edematous (CHF, cirrhosis), do NOT give normal saline		*Note: if patient is edematous (CHF, cirrhosis), do NOT give normal saline
	**If patient is hypokalemic KCl will correct both hypoK AND alkalosis		**If patient is hypokalemic, KCl will correct both hypoK AND alkalosis

	==See Also==		==See Also==

Kxl328: /* Chloride-resistant */

2018-06-20T14:47:47Z

Chloride-resistant

← Revisión anterior		Revisión del 14:47 20 jun 2018
Línea 30:		Línea 30:
	'''Urine Cl > 20 mEq/L'''		'''Urine Cl > 20 mEq/L'''
	*Exogenous alkali (Nabicarb + renal failure, metabolism of lactic acid, or ketoacids)		*Exogenous alkali (Nabicarb + renal failure, metabolism of lactic acid, or ketoacids)
			**Potassium acetate
	*[[Milk alkali syndrome]]		*[[Milk alkali syndrome]]
	*[[Hypercalcemia]] (inability to concentrate urine leads to hypovolemia)		*[[Hypercalcemia]] (inability to concentrate urine leads to hypovolemia)

Mholtz: Text replacement - "==References== " to "==References== "

2017-07-24T01:12:43Z

Text replacement - "==References== " to "==References== <references/> "

← Revisión anterior		Revisión del 01:12 24 jul 2017
Línea 75:		Línea 75:

	==References==		==References==
			<references/>
	[[Category:FEN]]		[[Category:FEN]]
	[[Category:Toxicology]]		[[Category:Toxicology]]

Mholtz: Text replacement - "->" to "→"

2017-02-09T01:48:12Z

Text replacement - "->" to "→"

← Revisión anterior		Revisión del 01:48 9 feb 2017
Línea 61:		Línea 61:
	#**Delivery of Cl to distal tubule increases Cl/bicarb exchange		#**Delivery of Cl to distal tubule increases Cl/bicarb exchange
	#Correct potassium depletion		#Correct potassium depletion
	#*Giving K+ leads to movement of H+ out of cells -> acidosis		#*Giving K+ leads to movement of H+ out of cells → acidosis
	#*Giving K+ stops hypokalemia-induced distal H+/K+ pump		#*Giving K+ stops hypokalemia-induced distal H+/K+ pump
	#Correct chloride depletion		#Correct chloride depletion

Rossdonaldson1: Text replacement - "Diarrhea" to "Diarrhea"

2016-09-24T13:12:44Z

Text replacement - "*Diarrhea" to "*Diarrhea"

← Revisión anterior		Revisión del 13:12 24 sep 2016
Línea 22:		Línea 22:
	#*[[Bulemia]]		#*[[Bulemia]]
	#Loss of colonic secretions		#Loss of colonic secretions
	#*Diarrhea		#*[[Diarrhea]]
	#*Congenital chloridorrhea		#*Congenital chloridorrhea
	#*Villous adenoma		#*Villous adenoma

Ostermayer: /* Clinical Features */

2016-09-01T01:44:24Z

Clinical Features

← Revisión anterior		Revisión del 01:44 1 sep 2016
Línea 9:		Línea 9:

	==Clinical Features==		==Clinical Features==
	Symptoms are non specific and usually result from the concomitant [[hypokalemia]] or [[hypocalcemia]]. Common ~~complaints~~ include		Symptoms are non specific and usually result from the concomitant [[hypokalemia]] or [[hypocalcemia]]. Common signs and symptoms include
	*Weakness/Fatigue		*Weakness/Fatigue
	*Vomiting or diarrhea		*Vomiting or diarrhea

Ostermayer: /* Clinical Features */

2016-09-01T01:44:09Z

Clinical Features

← Revisión anterior		Revisión del 01:44 1 sep 2016
Línea 9:		Línea 9:

	==Clinical Features==		==Clinical Features==
			Symptoms are non specific and usually result from the concomitant [[hypokalemia]] or [[hypocalcemia]]. Common complaints include
			*Weakness/Fatigue
			*Vomiting or diarrhea
			*Hypoventilation

	==Differential Diagnosis==		==Differential Diagnosis==

Metabolic alkalosis - Revision history

Danbot: Add evidence-based Disposition section

ClaireLewis: /* Chloride-resistant */

ClaireLewis: /* Background */

ClaireLewis at 18:04, 22 September 2019

Kxl328: /* Chloride-resistant */

Mholtz: Text replacement - "==References== " to "==References== "

Mholtz: Text replacement - "->" to "→"

Rossdonaldson1: Text replacement - "*Diarrhea" to "*Diarrhea"

Ostermayer: /* Clinical Features */

Ostermayer: /* Clinical Features */

Rossdonaldson1: Text replacement - "Diarrhea" to "Diarrhea"