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| ==Epidemiology and Demographics== | | ==Epidemiology and Demographics== |
| It is the most common acid-base disorder seen in hospital in the United States. | | It is the most common acid-base disorder seen in hospital in the United States. |
| ==Causes==
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| * [[Urine chloride]] is used to narrow down the differential diagnosis of [[metabolic alkalosis]].
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| ===Low urine chloride (<10mEq/dl)===
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| * Patients with low urine chloride and metabolic alkalosis respond well to treatment with volume repletion with saline, thus these conditions are often referred as '''saline-responsive metabolic alkalosis'''. Some conditions of volume depletions are:
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| ** [[Vomiting]],
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| ** [[Nasogastric tube]] suction
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| ** Over diuresis
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| * Other condition with similar presentation but without volume depletion is [[hypercapnia]]
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|
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| ===Normal urine chloride (> 10mEQ/dL)===
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| * With [[hypertension]]
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| ** [[Cushing's syndrome]],
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| ** Primary aldosteronism ([[Conn's syndrome]]),
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| ** [[Renal artery stenosis]]
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| ** [[Renal failure]] + excess supplemented alkali
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| * Without [[hypertension]]
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| ** [[Hypomagnesemia]]
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| ** [[Hypokalemia]],
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| ** [[Bartter's syndrome]] (defect of sodium chloride resorption),
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| ** [[Licorice]] ingestion (increases [[cortisol]])
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|
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| ===Common Causes===
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|
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| ===Causes by Organ System===
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|
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| {|style="width:80%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Dilated cardiomyopathy]], [[Malignant hypertension]], [[Renovascular hypertension]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[Aldosterone]], [[Carbenoxolone]], [[Diuretics]], [[Ethacrynic Acid]], [[Fludrocortisone]], [[Glucocorticoids]], [[Intravenous Pencillins]], [[Laxatives]], [[Lydia Pinkham's vegetable compound]], [[Mineralocorticoids]], [[Pramipexole]], [[Sodium bicarbonate]], [[Tolazoline]], [[Tromethamine]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Cushing syndrome]], [[Glucocorticoid-remediable hyperaldosteronism]], [[Hyperaldosteronism]], [[11 beta hydroxylase deficiency]], [[C17-hydroxylase deficiency]], [[Conn syndrome]], [[Bilateral adrenal hyperplasia]], [[Adrenal adenoma]], [[Adrenal carcinoma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| [[Gastric fistula]], [[Villous adenoma]], [[VIPoma]], [[Congenital chloride diarrhea]], [[Cystic fibrosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| [[11 beta hydroxylase deficiency]], [[Bartter syndrome]], [[C17-hydroxylase deficiency]], [[Congenital chloride diarrhea]], [[Cystic fibrosis]], [[Gietelman syndrome]], [[Glucocorticoid receptor defect]], [[Liddle syndrome]], [[SeSAME syndrome]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| [[Massive blood transfusion]], [[Nasogastric suction]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| [[Hypercalcemia]], [[Hypokalemia]], [[Hypomagnesemia]], [[Refeeding syndrome]], [[Glucocorticoid receptor defect]], [[Glycyrrhizic acid]], [[Licorice]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Adrenal adenoma]], [[Adrenal carcinoma]], [[Conn syndrome]], [[Hemangiopericytoma]],[[VIPoma]], [[Juxtaglomerular cell tumor]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| [[Aldosterone]], [[Carbenoxolone]], [[Diuretics]], [[Fludrocortisone]], [[Glucocorticoids]], [[Intravenous Pencillins]], [[Laxatives]], [[Lydia Pinkham's vegetable compound]], [[Mineralocorticoids]], [[Sodium bicarbonate]], [[Tolazoline]], [[Tromethamine]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Cystic fibrosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| [[Bilateral adrenal hyperplasia]], [[Hypokalemic distal renal tubular acidosis]], [[Juxtaglomerular cell tumor]], [[Milk-alkali syndrome]], [[Renovascular hypertension]], [[Bartter syndrome]], [[Gietelman syndrome]], [[Liddle syndrome]], [[Adrenal adenoma]], [[Adrenal carcinoma]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| [[Cystic fibrosis]]
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| [[Chewing tobacco]], [[Glycyrrhizic acid]], [[Licorice]], [[Posthypercapnia]], [[Vomiting]], [[Laxatives]], [[Refeeding syndrome]], [[Milk-alkali syndrome]]
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| |-
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| |}
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|
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| ===Causes in Alphabetical Order===
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| {{MultiCol}}
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| *[[11 beta hydroxylase deficiency]]
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| *[[Adrenal adenoma]]
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| *[[Adrenal carcinoma]]
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| *[[Aldosterone]]
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| *[[Bartter syndrome]]
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| *[[Bilateral adrenal hyperplasia]]
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| *[[C17-hydroxylase deficiency]]
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| *[[Carbenoxolone]]
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| *[[Chewing tobacco]]
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| *[[Congenital chloride diarrhea]]
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| *[[Conn syndrome]]
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| *[[Cushing syndrome]]
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| *[[Cystic fibrosis]]
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| *[[Dilated cardiomyopathy]]
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| *[[Diuretics]]
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| *[[Fludrocortisone]]
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| *[[Gastric fistula]]
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| *[[Gietelman syndrome]]
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| *[[Glucocorticoid receptor defect]]
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| *[[Glucocorticoid-remediable hyperaldosteronism]]
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| *[[Glucocorticoids]]
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| *[[Glycyrrhizic acid]]
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| *[[Hemangiopericytoma]]
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| *[[Hyperaldosteronism]]
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| *[[Hypercalcemia]]
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| {{ColBreak}}
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| *[[Hypokalemia]]
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| *[[Hypokalemic distal renal tubular acidosis]]
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| *[[Hypomagnesemia]]
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| *[[Intravenous Pencillins]]
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| *[[Juxtaglomerular cell tumor]]
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| *[[Laxatives]]
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| *[[Licorice]]
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| *[[Liddle syndrome]]
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| *[[Lydia Pinkham's vegetable compound]]
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| *[[Malignant hypertension]]
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| *[[Massive blood transfusion]]
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| *[[Milk-alkali syndrome]]
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| *[[Mineralocorticoids]]
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| *[[Nasogastric suction]]
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| *[[Posthypercapnia]]
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| *[[Refeeding syndrome]]
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| *[[Renovascular hypertension]]
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| *[[SeSAME syndrome]]
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| *[[Sodium bicarbonate]]
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| *[[Tolazoline]]
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| *[[Tromethamine]]
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| *[[Villous adenoma]]
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| *[[VIPoma]]
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| *[[Vomiting]]
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| {{EndMultiCol}}
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|
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
