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🌱 來自: Huppert’s Notes

Metabolic Alkalosis🚧 施工中

Metabolic Alkalosis A Brief Pathophysiologic Review

Metabolic Alkalosis

↑ pH, ↑ HCO 3– (Immediate respiratory compensation = Hypoventilation: ↑PaCO2)

•   Clinical features: No characteristic signs/symptoms; history most helpful

•   Etiology:

-   Saline-sensitive (urine chloride <15 mEq/L): ECF contraction and hypokalemia; Ddx includes vomiting, loop/thiazide diuretics, NGT suction, and villous adenoma of colon (via diarrhea with high Cl- content)

-   Saline-resistant (urine chloride >15 mEq/L): ECF expansion and HTN; Ddx includes primary hyperaldosteronism, Cushing’s, active diuretic use, stimulant or laxative abuse

•   Treatment: Treat underlying cause; normal saline restores ECF volume if volume contracted; spironolactone helps if volume expanded

FIGURE 6.6: Approach to acid–base problems. Evaluation of acid-base disturbances begins with an evaluation of pH, followed by an evaluation of PaCO2. Calculation for appropriate compensation can help determine if multiple concurrent acid-base disturbances are present.