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{{Infobox_Disease |
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  Name          = {{PAGENAME}} |
{{Metabolic alkalosis}}
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'''For patient information, click [[Metabolic alkalosis (patient information)|here]]'''
  Caption        = |
  DiseasesDB    = 402 |
  ICD10          = {{ICD10|E|87|3|e|70}} |
  ICD9          = {{ICD9|276.3}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID        = |
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{{SI}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh@perfuse.org]
==Overview==
'''Metabolic alkalosis''' is an elevation of the pH in the bloodstream which results from decreased [[hydrogen]] ion concentration leading to increased [[bicarbonate]] and [[carbon dioxide]] concentrations, or alternatively a direct result of increased [[bicarbonate]] concentrations.


==Pathophysiology==
{{CMG}}; {{AE}} [[Priyamvada Singh|Priyamvada Singh, M.D.]] [mailto:psingh13579@gmail.com]


===Loss of hydrogen ions===
{{SK}}
====GI loss====
* [[Vomiting]] (excretion of hydrogen ions and the retention of bicarbonate)
* [[Nasogastric tube]] suction
====Renal====
* Over-[[diuresis]]
* [[Hyperaldosteronism]] causing retention of sodium followed with compensatory excretion of hydrogen
* Administration of non-resorbable anions such as, [[penicillin]], [[carbenicillin]], which complexs with positively-charged hydrogen ions in the [[renal tubules]].


===Increase in the serum bicarbonate===
==[[Metabolic alkalosis overview|Overview]]==
* Ingestion of [[sodium bicarbonate]], baking soda, citrate, lactate, or acetate.
===Shift of hydrogen ions into intracellular space===
* Seen in [[hypokalemia]].  Due to a low extracellular potassium concentration, potassium shifts out of the cells, and in order to maintain electrical neutrality, hydrogen shifts into the cells, leaving behind bicarbonate.
===Contraction alkalosis===
* This results from a loss of water in the extracellular space which is poor in bicarbonate, typically from diuretic use.  Since water is lost while bicarbonate is retained, the concentration of bicarbonate increases.


===Compensation for Metabolic Alkalosis===
==[[Metabolic alkalosis historical perspective|Historical Perspective]]==
* The body attempts to compensate for the increase in pH by retaining [[carbon dioxide]] (CO<sub>2</sub>) through [[hypoventilation]] ([[respiratory compensation]]). CO<sub>2</sub> combines with elements in the bloodstream to form carbonic acid, thus decreasing pH.
* The pCO2 rises 0.5 - 1 for every 1 unit increase in serum HCO3 from a baseline of 24. 
* The maximum pCO2 in compensation is 55-60.
* [[Renal compensation]] for metabolic alkalosis consists of increased excretion of HCO<sub>3</sub><sup>-</sup> (bicarbonate), because the filtered load of HCO<sub>3</sub><sup>-</sup> exceeds the ability of the renal tubule to reabsorb it.


==Epidemiology and Demographics==
==[[Metabolic alkalosis classification|Classification]]==
It is the most common acid-base disorder seen in hospital in the United States.
==Causes==
* [[Urine chloride]] is used to narrow down the differential diagnosis of [[metabolic alkalosis]].
===Low urine chloride (<10mEq/dl)===
* 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:
** [[Vomiting]],
** [[Nasogastric tube]] suction
** Over diuresis
* Other condition with similar presentation but without volume depletion is [[hypercapnia]]


===Normal urine chloride (> 10mEQ/dL)===
==[[Metabolic alkalosis pathophysiology|Pathophysiology]]==
* With [[hypertension]]
** [[Cushing's syndrome]],
** Primary aldosteronism ([[Conn's syndrome]]),
** [[Renal artery stenosis]]
** [[Renal failure]] + excess supplemented alkali
* Without [[hypertension]]
** [[Hypomagnesemia]]
** [[Hypokalemia]],
** [[Bartter's syndrome]] (defect of sodium chloride resorption),
** [[Licorice]] ingestion (increases [[cortisol]])


===Common Causes===
==[[Metabolic alkalosis  causes|Causes]]==


===Causes by Organ System===
==[[Metabolic alkalosis differential diagnosis|Differentiating Metabolic alkalosis from other Diseases]]==


===Causes in Alphabetical Order===
==[[Metabolic alkalosis epidemiology and demographics|Epidemiology and Demographics]]==


{{MultiCol}}
==[[Metabolic alkalosis risk factors|Risk Factors]]==
*[[11 beta hydroxylase deficiency]]
*[[Adrenal adenoma]]
*[[Adrenal carcinoma]]
*[[Aldosterone]]
*[[Bartter syndrome]]
*[[Bilateral adrenal hyperplasia]]
*[[C17-hydroxylase deficiency]]
*[[Carbenoxolone]]
*[[Chewing tobacco]]
*[[Congenital chloride diarrhea]]
*[[Conn syndrome]]
*[[Cushing syndrome]]
*[[Cystic fibrosis]]
*[[Dilated cardiomyopathy]]
*[[Diuretics]]
*[[Fludrocortisone]]
*[[Gastric fistula]]
*[[Gietelman syndrome]]
*[[Glucocorticoid receptor defect]]
*[[Glucocorticoid-remediable hyperaldosteronism]]
*[[Glucocorticoids]]
*[[Glycyrrhizic acid]]
*[[Hemangiopericytoma]]
*[[Hyperaldosteronism]]
*[[Hypercalcemia]]
{{ColBreak}}
*[[Hypokalemia]]
*[[Hypokalemic distal renal tubular acidosis]]
*[[Hypomagnesemia]]
*[[Intravenous Pencillins]]
*[[Juxtaglomerular cell tumor]]
*[[Laxatives]]
*[[Licorice]]
*[[Liddle syndrome]]
*[[Lydia Pinkham's vegetable compound]]
*[[Malignant hypertension]]
*[[Massive blood transfusion]]
*[[Milk-alkali syndrome]]
*[[Mineralocorticoids]]
*[[Nasogastric suction]]
*[[Posthypercapnia]]
*[[Refeeding syndrome]]
*[[Renovascular hypertension]]
*[[SeSAME syndrome]]
*[[Sodium bicarbonate]]
*[[Tolazoline]]
*[[Tromethamine]]
*[[Villous adenoma]]
*[[VIPoma]]
*[[Vomiting]]
{{EndMultiCol}}


==References==
==[[Metabolic alkalosis screening|Screening]]==
{{Reflist|2}}


[[Category:Nephrology]]
==[[Metabolic alkalosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
==Diagnosis==
[[Metabolic alkalosis diagnostic study of choice|Diagnostic study of choice]] | [[Metabolic alkalosis history and symptoms|History and Symptoms]] | [[Metabolic alkalosis physical examination|Physical Examination]] | [[Metabolic alkalosis laboratory findings|Laboratory Findings]] | [[Metabolic alkalosis electrocardiogram|Electrocardiogram]] | [[Metabolic alkalosis x ray|X-Ray Findings]] | [[Metabolic alkalosis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Metabolic alkalosis CT scan|CT-Scan Findings]] | [[Metabolic alkalosis MRI|MRI Findings]] | [[Metabolic alkalosis other imaging findings|Other Imaging Findings]] | [[Metabolic alkalosis other diagnostic studies|Other Diagnostic Studies]]
 
==Treatment==
[[Metabolic alkalosis medical therapy|Medical Therapy]] | [[Metabolic alkalosis surgery|Surgery]] | [[Metabolic alkalosis primary prevention|Primary Prevention]] | [[Metabolic alkalosis secondary prevention|Secondary Prevention]] | [[Metabolic alkalosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Metabolic alkalosis future or investigational therapies|Future or Investigational Therapies]]
 
==Case Studies==
[[Metabolic alkalosis case study one|Case #1]]
 
==Related Chapters==
* [[Respiratory alkalosis]]
* [[Acid-base imbalance]]
* [[Metabolic acidosis]]
* [[Respiratory acidosis]]
* [[Anion gap]]
* [[Hypocalcemia]]
[[Category:Electrolyte disturbance]]
[[Category:Electrolyte disturbance]]
[[Category:Inborn errors of metabolism]]
[[Category:Inborn errors of metabolism]]
[[Category:Signs and symptoms]]
[[Category:Medical tests]]
 
[[Category:Laboratory Test]]
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Revision as of 14:34, 16 May 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.D. [2]

Synonyms and keywords:

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Metabolic alkalosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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