Metabolic Alkalosis
Metabolic alkalosis is the most common acid-base disorder in hospitalized patients. Metabolic alkalosis involves a net gain of base, or a net loss of acid from the extracellular fluid. Its genesis needs the presence of both initiating and maintenance fact
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Metabolic Alkalosis
Contents 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13
Etiology of Metabolic Alkalosis ................................................................................... Pathways Leading to Metabolic Alkalosis .................................................................... Maintenance Factors for Metabolic Alkalosis .............................................................. Maintenance Factors for Metabolic Alkalosis: Volume Contraction ............................ Maintenance Factors for Metabolic Alkalosis: Dyselectrolytemias ............................. Compensation for Metabolic Alkalosis ........................................................................ Urinary Sodium............................................................................................................. Diagnostic Utility of Urinary Chloride (1) ................................................................... The Diagnostic Utility of Urinary Chloride (2) ............................................................ Diagnostic Utility of Urinary Chloride (3) ................................................................... Some Special Causes of Metabolic Alkalosis............................................................... Metabolic Alkalosis Can Result in Hypoxemia ............................................................ Metabolic Alkalosis and the Respiratory Drive ............................................................
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A. Hasan, Handbook of Blood Gas/Acid-Base Interpretation, DOI 10.1007/978-1-4471-4315-4_10, © Springer-Verlag London 2013
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10.1
Metabolic Alkalosis
Etiology of Metabolic Alkalosis
Metabolic alkalosis is the most common acid-base disorder in hospitalized patients. Metabolic alkalosis involves a net gain of base, or a net loss of acid from the extracellular fluid. Its genesis needs the presence of both initiating and maintenance factors. Of itself, an initating factor cannot sustain a metabolic acidosis. Maintenance factors impede the excretion of the surplus bicarbonate and result in perpetuation of the alkalosis. Increased extracellular bicarbonate Net gain of bicarbonate
Net gain of bicarbonate from an endogenous source Metabolism of keto-anions Net gain of bicarbonate from an exogenous source Sodium bicarbonate infusion Ingestion of bicarbonate in renal failure Metabolism by liver of organic anions to bicarbonate: Citrate in massive blood transfusion Lactate Acetate
Fluid and ion shifts producing a relative increase in extracellular bicarbonate
Volume contraction in the presence of a relatively preserved extracellular bicarbonate content.
Decreased extracellular hydrogen ions Renal loss of hydrogen ions
Diuretic use Post hypercapnic Primary mineralocorticoid excess states
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Gastrointestinal loss of hydrogen ions
Vomiting Continuous nasogastric tube aspiration
Galla, JH. Metabolic alkalosis. J Am Soc Nephrol 2000;11:369. Garella, S, Chang, BS, Kahn, SI. Dilu
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