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🌱來自: Metabolic Alkalosis A Brief Pathophysiologic Review

Serum Chloride Concentration and Metabolic Alkalosis

Hyper- or hypochloremia can reflect water/hydration disorders, acid/base disorders, or both. When an abnormal [Cl−] is secondary to a water/hydration disorder, there is a proportional degree of hyper- or hyponatremia. Thus the abnormal [Cl−] coexists with an abnormal [Na+] in a 1:1.4 ratio. This relationship is disrupted in acid-base disorders such as metabolic alkalosis. The elevated [HCO3−] with metabolic alkalosis is generally associated with a reciprocally reduced [Cl−] independent of [Na+]. The electrolyte profile, or Gamblegram (Figure 2), shows why the increased [HCO3−] must be accompanied by a reduction of [Cl−] (independent of [Na+]), a reduction of the [AG−], or both (7,8). In fact, metabolic alkaloses reproducibly increase the [AG−] to a small degree, mostly owing to increased negative charge density of plasma proteins (9,10). Therefore, the relative [Cl−] decrease must be even greater.

However, an identical electrolyte pattern, increased [HCO3−] and reduced [Cl−], is also generated by compensation for chronic respiratory acidosis. Clinical assessment and arterial blood pH measurement will point toward the correct diagnosis—the blood pH is high-normal/overtly alkaline with metabolic alkalosis and low-normal/overtly acid with chronic respiratory acidosis. Venous blood pH, although less definitive than arterial, can also differentiate these disorders—add 0.03 pH units to the venous pH to approximate the arterial pH (11).

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• Serum Chloride Concentration and Metabolic Alkalosis:
• Hyper- or hypochloremia : can reflect water/hydration disorders, acid/base disorders, or both;
• When an abnormal [Cl−] is secondary to a water/hydration disorder : there is a proportional degree of hyper- or hyponatremia;
• The elevated [HCO3−] with metabolic alkalosis is generally associated with a reciprocally reduced [Cl−] : independent of [Na+];
• An identical electrolyte pattern : increased [HCO3−] and reduced [Cl−], is also generated by compensation for chronic respiratory acidosis;
• Clinical assessment and arterial blood pH measurement : will point toward the correct diagnosis—the blood pH is high-normal/overtly alkaline with metabolic alkalosis and low-normal/overtly acid with chronic respiratory acidosis.

窩的英文不太好，只好請估🐶

• 血清氯化物濃度和代謝性鹼中毒：
• 高氯血症或低氯血症：可以反映水/水合作用失調、酸/鹼失調，或兩者兼而有之；
• 當異常 [Cl−] 繼發於水/水合作用障礙時：存在一定程度的高鈉血症或低鈉血症；
• 伴有代謝性鹼中毒的 [HCO3−] 升高通常與 [Cl−] 相互降低相關：與 [Na+] 無關；
• 相同​​的電解質模式：增加 [HCO3−] 和減少 [Cl−]，也是由慢性呼吸性酸中毒的補償產生的；
• 臨床評估和動脈血 pH 值測量：將指向正確的診斷——血液 pH 值處於正常高值/明顯鹼性並伴有代謝性鹼中毒，而血液 pH 值處於正常低值/明顯酸性並伴有慢性呼吸性酸中毒。