metabolic alkalosis


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Related to metabolic alkalosis: metabolic acidosis, respiratory alkalosis

Metabolic Alkalosis

 

Definition

Metabolic alkalosis is a pH imbalance in which the body has accumulated too much of an alkaline substance, such as bicarbonate, and does not have enough acid to effectively neutralize the effects of the alkali.

Description

Metabolic alkalosis, as a disturbance of the body's acid/base balance, can be a mild condition, brought on by vomiting, the use of steroids or diuretic drugs, or the overuse of antacids or laxatives. Metabolic alkalosis can also indicate a more serious problem with a major organ such as the kidneys.

Causes and symptoms

Metabolic alkalosis occurs when the body has more base than acid in the system. Chemists use the term "pH" to decribe how acidic or alkaline (also called basic) a substance is. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is alkaline; the higher the number, the stronger the alkali. Blood pH is slightly alkaline, with a normal range of 7.36-7.44. Conditions that lead to a reduced amount of fluid in the body, like vomiting or excessive urination due to use of diuretic drugs, change the balance of fluids and salts. The blood levels of potassium and sodium can decrease dramatically, causing symptoms of metabolic alkalosis.
In cases of metabolic alkalosis, slowed breathing may be an initial symptom. The patient may have episodes of apnea (not breathing) that may go on 15 seconds or longer. Cyanosis, a bluish or purplish discoloration of the skin, may also develop as a sign of inadequate oxygen intake. Nausea, vomiting, and diarrhea may also occur. Other symptoms can include irritability, twitching, confusion, and picking at bedclothes. Rapid heart rate, irregular heart beats, and a drop in blood pressure are also symptoms. Severe cases can lead to convulsions and coma.

Diagnosis

Metabolic alkalosis may be suspected based on symptoms, but often may not be noticeable. The condition is usually confirmed by laboratory tests on blood and urine samples. Blood pH above 7.45 confirms the condition. Levels of other blood components, including salts like potassium, sodium, and chloride, fall below normal ranges. The level of bicarbonate in the blood will be high, usually greater than 29 mEq/L. Urine pH may rise to about 7.0 in metabolic alkalosis.

Treatment

Treatment focuses first on correcting the imbalance. An intravenous line may be started to administer fluids (generally normal saline, a salt water solution) and allow for the quick injection of other drugs that may be needed. Potassium chloride will be administered. Drugs to regulate blood pressure or heart rate, or to control nausea and vomiting might be given. Vital signs like pulse, respiration, blood pressure, and body temperature will be monitored. The underlying cause of the metabolic alkalosis must also be diagnosed and corrected.

Prognosis

If metabolic alkalosis is recognized and treated promptly, the patient may have no long-term complications; however, the underlying condition that caused the alkalosis needs to be corrected or managed. Severe metabolic alkalosis that is left untreated will lead to convulsions, heart failure, and coma.

Prevention

Patients receiving tube feedings or intravenous feedings must be monitored to prevent an imbalance of fluids and salts, particularly potassium, sodium, and chloride. Overuse of some drugs, including diuretics, laxatives, and antacids, should be avoided.

Resources

Books

Bennett, J. Claude, and Fred Plum, eds. "Acid-Base Disturbances." In Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.
DuBose, Thomas D., Jr. "Acidosis and Alkalosis" In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
"Fluid, Electrolyte, and Acid-Base Disorders." In Family Medicine Principles and Practices. 5th ed. New York: Springer-Verlag, 1998.
"Fluid & Electrolyte Disorders." In Current Medical Diagnosis and Treatment, 1998. 37th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1997.

Key terms

pH — A measurement of the acidity or alkalinity of a solution based on the amount of hydrogen ions available. Based on a scale of 14, a pH of 7.0 is neutral. A pH below 7.0 is an acid; the lower the number, the stronger the acid. A pH above 7.0 is a base; the higher the number, the stronger the base. Blood pH is slightly alkaline (basic) with a normal range of 7.36-7.44.

met·a·bol·ic al·ka·lo·sis

an alkalosis associated with an increased arterial plasma bicarbonate concentration, possibly resulting from an excessive intake of alkaline materials or an excessive loss of acid in the urine or through persistent vomiting; the base excess and standard bicarbonate are both elevated.
See also: compensated alkalosis.

metabolic alkalosis

n.

metabolic alkalosis

A condition in which there is an increased pH due to either a decrease in acids or an excess of bicarbonate in tissues.

Clinical findings
Slow, shallow breathing; irritability; confusion.

Aetiology
Loss of acids due to hyperemesis, gastric suction, loss of K+ due to increased renal excretion (e.g., diuretic therapy), steroid use, excess/overuse of antacids.
 
Compensation
The lungs compensate for metabolic alkalosis by retaining CO2 with slower respiration; the kidneys are less effective than the lungs in compensating for metabolic acidosis, which act by increasing bicarbonate excretion.

metabolic alkalosis

Physiology A condition in which there is a ↑ pH due to either an ↓ in acids or excess bicarbonate Lab pH > 7.42, HCO3 > 26 mEq/L, PaCO2 > 45 mm Hg Etiology Loss of acids due to hyperemesis, gastric suction, loss of K+ due to ↑ renal excretion–eg, diuretic therapy, steroid use, excess–eg, overuse of antacids Clinical Slow shallow breathing, irritability, confusion. See Metabolic acidosis, Respiratory acidosis, Respiratory alkalosis.

met·a·bol·ic al·ka·lo·sis

(met'ă-bol'ik al'kă-lō'sis)
A disorder associated with an increased arterial bicarbonate concentration, resulting from an excessive intake of alkaline materials or an excessive loss of acid in the urine or through persistent vomiting; the base excess and standard bicarbonate are both elevated.
See also: compensated alkalosis
References in periodicals archive ?
Bartter syndrome is named after Fredrick Bartter who first described a case of hypokalaemic metabolic alkalosis along with hyperaldosteronism and normal blood pressure.
Furthermore, despite postdialysis metabolic alkalosis, PaC[O.sub.2] levels paradoxically decreased as compared to predialysis values.
Regarding metabolic dependence, we hypothesize that SCLC might have metabolic benefits from hyponatremia and metabolic alkalosis in the tumor microenvironment, which might favor tumor growth and hinder antitumor immune response.
In conclusion, hypokalemia and metabolic alkalosis may not be found during the first year of life of Bartter syndrome patients.
Shanbag, "Meropenem-induced hypokalemia and metabolic alkalosis," Indian Journal of Pharmacology, vol.
Respiratory and metabolic alkalosis on presentation were likely due to pain/anxiety and volume depletion, respectively.
There are four major acid-base disorders: respiratory acidosis, respiratory alkalosis, metabolic acidosis and metabolic alkalosis. Typically the interpretation of blood gases is a simple process.
Abnormally low serum bicarbonate (metabolic acidosis) was observed in 10(12.8%) and a high bicarbonate level (metabolic alkalosis) in 2(2.5%) cases.
The extremely high bicarbonate and low chloride are almost certainly due to metabolic alkalosis caused by vomiting associated with SMA syndrome (1).
Metabolic alkalosis blunts the response of animals to the parathyroid hormone and increases the risk of subclinical hypocalcemia and milk fever.
We report a case of a chronic alcoholic patient who had primary wide anion-gap metabolic acidosis (concomitant severe lactic acidosis and ketoacidosis) caused by alcohol intoxication coupled with thiamine deficiency and concurrent respiratory and metabolic alkalosis, thus highlighting the complexity of metabolic derangements in persons with chronic alcohol abuse.
Defective sodium-chloride absorption at this site causes urinary wasting of sodium, chloride, potassium, and magnesium, resulting in hypokalemic metabolic alkalosis with normal or reduced blood pressure [1].