Info
🌱 來自: Huppert’s Notes
Metabolic Alkalosis🚧 施工中
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.