endocrine and metabolic disorders
Metabolic Alkalosis
Key Points
Metabolic alkalosis is bicarbonate (HCO3−) accumulation due to acid loss, alkali administration, intracellular shift of hydrogen ion, or renal HCO3−retention. The most common causes are volume depletion (particularly when involving loss of gastric acid and chloride (Cl) due to recurrent vomiting or nasogastric suction) and diuretic use. Metabolic alkalosis involving loss or excess secretion of Cl is termed chloride-responsive. Treat the cause and give patients with chloride-responsive metabolic alkalosis 0.9% saline IV. Chloride-resistant metabolic alkalosis is due to increased aldosterone effect. Treatment of chloride-resistant metabolic alkalosis involves correction of hyperaldosteronism. 