TOC  |  Lytes  | Acid-Base Disturbances

METABOLIC ALKALOSIS

A. NaCl resistant (Urine Cl > 20 mmoles/l) - Hyperadrenocorticism
1. Excess mineralocorticoid acitivity: Hyperaldosteronism, Cushing's syndrome, Bartter's syndrome, Excess licorice intake
2. Profound potassium depletion

B. NaCl responsive (Urine Cl < 10 mmoles/l) - Volume Depletion (hypochloremic)
1. GI disorders: Vomiting, Gastric drainage, Colon villous adenoma, Chloride diarrhea
2. Diuretic Rx; decreased fluid intake
3. Rapid correction of chronic hypercapnia
4. Cystic fibrosis

C. Unclassified
1. Excessive Alkali intake: Na-Bicarbonate, Sodium (Na) penicillins, Na citrate (in blood products as stabilizer)
2. Milk alkali syndrome
3. Non parathyroid hypercalcemia
4. Massive transfusion
5. Glucose ingestion after starvation
6. Hypoproteinemia: decreased anion gap
                                                                                                                       

Respiratory Alkalosis

1. Hypoxic Drive Increased : COPD, Heart disease, High Altitudes,
2. Overventilation
3. Sepsis (usually Gram-negative)
4. Exercise
5. Hepatic Cirrhosis, Failure
6. Respiratory Center Stimulation: Fever, Salicylates (independent of metabolic acidosis), Theophylline, Anxiety

Ref: Outlines in Clinical Medicine on Physicians' Online 2000

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