Metabolic Alkalosis

  • Metabolic changes that result in the accumulation of base
  • Accumulation of base occurs as a result of
    • Increased acid loss
    • Excess alkali intake

Causes

  • G          GIT excess acid loss
    • Vomit (and pyloric stenosis)
    • NGT drainage
    • Diarrhoea
    • Ileostomy
    • Dehydration
  • R          Renal excess acid loss
    • Bartter’s
    • Gitelman’s
    • Diuretics (Loss of H+, K+, Cl-)
  • O          Overdose of base
    • Antacid OD, Laxative, Milk-alkali syndrome
    • Massive Hartmann’s transfusion
    • Iatrogenic use of HCO3
  • E           Endocrine
    • Cushing
    • Steroid excess
    • Hyperaldosteronism

Clinical

  • Shift O2 dissociation curve to left (increased affinity for Hb-O2)
    • Right shift with increase TEMP, 2-3 DPG, H+
  • Hypokalemia, hypocalcaemia, hypochloraemia
  • Symptoms related to HYPOcalcaemia and HYPOkalaemia
    • Dizzy, light-headed
    • Chest tightness
    • Anxiety, dysphasia…..laryngospasm

Correction

  • Correct underlying problem
  • Improve renal bicarbonate excretion (Cl, K and volume)
  • Correct electrolyte imbalance
  • Oxygen
  • Avoid hyperventilation
  • Rarely, acetazolamide or HCl infusion
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