metabolic-alkalosis

• Metabolic Alkalosis A Brief Pathophysiologic Review
• Pathophysiology-metabolic-alkalosis
• Etiologies-of-Metabolic-Alkalosis

Workup metabolic alkalosis

• Check volume status and UCl
• UCl <25 mEq/L → saline responsive
• UCl >40 mEq/L → saline resistant (unless currently receiving diuretics)
• (UNa unreliable determinant of volume status in alkalemia → ↑ HCO3- excretion → ↑ Na excretion; negatively charged HCO3- w/ Na+ maintaining electrical neutrality)
• If UCl >40 and volume replete, ✓ UK; UK <20 laxative abuse; UK >30, ✓ blood pressure

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Treatment of severe metabolic alkalosis (pH >7.6) (JASN 2012;23:204)

• If saline responsive: resuscitate with Cl-rich solution (NS), replete K, d/c diuretics cardiopulmonary disease precludes hydration, can use KCl, acetazolamide, HCl
• hyperaldosteronism: treat underlying condition, K-sparing diuretic, resect adenoma if 1o