Metabolic alkalosis in patients receiving simultaneous loop diuretics. May 07, 2020 metabolic alkalosis most commonly results from severe cases of vomiting that cause you to lose the acidic fluids in your stomach. The severity of a metabolic alkalosis is determined by the difference between the actual hco3 and the expected hco3. In sodium chlorideresponsive metabolic alkalosis, there is a decrease in real or effective extracellular volume and hypochloremia accompanied by avid renal reabsorption of sodium chloride and a urine chloride concentration of less than 10 meql although, in diureticinduced metabolic alkalosis. Acidosis and alkalosis when the body has too much acid the condition is called acidosis. Generation occurs by loss of protons from the ecf into the. Metabolic alkalosis is characterized by a high ph loss of hydrogen ions and high plasma bicarbonate caused by excessive intake of sodium bicarbonate, loss of gastricintestinal acid, renal excretion of hydrogen and chloride, prolonged hypercalcemia, hypokalemia, and hyperaldosteronism. The pubmed database was searched for relevant basic science and clinical articles in addition to the leading journals in nephrology, endocrinology, critical care, and internal medicine. Dec 10, 2020 the management of metabolic alkalosis depends primarily on the underlying etiology and on the patients volume status. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. In these transient states, the urinary ph should be relatively alkaline. This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations. Metabolic alkalosis an overview sciencedirect topics. Metabolic alkalosis litfl medical blog ccc acidbase.
Metabolic alkalosis is indicated by an increase in plasma bicarbonate hco3 level. Salineresponsive normotensive extracellular volume contraction and hypokalemia. A metabolic condition in which the arterial ph is elevated beyond the normal range 7. Some causes of metabolic alkalosis respond to treat. The association of spontaneous primary metabolic alkalosis with azotemia has received little attention.
The course of metabolic alkalosis can be divided into generation, maintenance, and correction phases 6. Metabolic acidosis is further classified into aniongap agma and hyperchloremic normal aniongap nagma based on serum anion gap ag. This condition is always secondary to an underlying cause. Acidbase and electrolyte teaching case treatment of severe. A metabolic alkalosis arises from an abnormal process generating excess hco3.
Although base administration is helpful in the management of chronic metabolic acidosis, it is controversial in acute metabolic acidosis. There are several possible causes of metabolic alkalosis in patients. Prevention and management of metabolic alkalosis sage journals. However, its clinical importance has only recently been recognized. It is a type of metabolic condition, which practically occurs due to decrease in the concentration of hydrogen ion. The severity of alkalosis depends on the severity of u. Cimetidine in the management of metabolic alkalosis induced. We detail the importance of understanding the kidney pathophysiology and. Suggests presents of metabolic alkalosis or respiratory acidosis c. Jan 15, 2009 acetazolamide in the treatment of metabolic alkalosis in critically ill patients after correcting for fluid and electrolyte abnormalities, examined the effect of acetazolamide 500mg iv on acidbase status of 30 ventilated patients in all patients, there was a fall of total serum hco3. The management of metabolic alkalosis depends primarily on the underlying etiology and on the patients volume status.
Suggests presence of metabolic acidosis or respiratory alkalosis b. This case illustrates the important differences in pathogenesis, diagnosis, and management of this common acidbase disorder in patients without kidney function. Metabolic alkalosis endocrine and metabolic disorders. The diagnosis of metabolic alkalosis is established by noting ph, serum bicarbonate elevated and pco2 compensatory elevation. Sep 24, 2018 fully compensated metabolic alkalosis usually comes on more gradually after uncompensated metabolic alkalosis has occurred. Metabolic alkalosis is defined by an arterial ph 7. Metabolic alkalosis is a unique acidbase disorder because it can be induced and sustained by functional alterations in renal ion transport. Metabolic alkalosis is characterized by a variation in the ph levels beyond the normal range of 7. Metabolic alkalosis is a metabolic condition in which the ph of tissue is elevated beyond the normal range 7. If acidosis exists in the body for long periods of time, the condition creates a. Desired outcomes display serum bicarbonate and electrolytes wnl. Multiple mechanisms are also responsible for the persistence, or maintenance, of metabolic alkalosis.
Pathophysiology, evaluation and management of metabolic acidosis. Causes of metabolic alkalosis or a loss of acids as in vomiting or ng tube suctioning, or an increase in alkaline substances like with excessive use of antacids or if the kidneys hold on to too much bicarb. Pathophysiology, evaluation, and management of metabolic. This is typically seen in children with chronic respiratory acidosis secondary to chronic lung disease such as bronchopulmonary dysplasia from. Feb 02, 2017 management of metabolic alkalosis in patients with renal failure continuous venovenous hemofiltration can remove 20 to 30 lday of an ultrafiltrate of plasma, and a bicarbonate free replacement solution can be used to reduce serum hco3 and increase serum cl. Metabolic alkalosis is an increase in blood ph to 7.
Sep 21, 2019 most commonly used diuretic for metabolic alkalosis and perhaps the most effective. In patients with metabolic alkalosis associated with volume contraction clsensitive metabolic alkalosis, it is critical to give isotonic saline 0. Metabolic alkalosis metabolic alkalosis occurs when hco3is increased, usually as the result of excessive loss of metabolic acids. It is the consequence of disorders that cause either a loss of hydrogen ions from the body or an increase in plasma hco3.
Metabolic alkalosis, either as a primary disturbance or as renal compensation of hypercapnia, occurs in about 25% of critically ill patients and may contribute to overly prolonged mechanical ventilation and high patient mortality reaching 80% with a ph 7. Acidosis creates an inappropriately low level of bicarbonate in the blood. Management of metabolic alkalosis in patients with azotemia. Pdf the patient with metabolic alkalosis researchgate. Oct 27, 2018 metabolic alkalosis defined by the increase of both plasma hco3 level 26 mmoll and blood arterial ph 7. Common causes of metabolic alkalosis pt master guide. Pdf diagnosis and treatment of metabolic alkalosis researchgate. Management of metabolic alkalosis deranged physiology. As the kidney has a large capacity to excrete hco3, management usually requires treatment of the processes that are generating as well maintaining the alkalosis. For metabolic alkalosis to continue both generation and maintenance of high levels of bicarbonate are necessary. Metabolic alkalosis is a frequent finding in critically ill patients l3. Description metabolic alkalosis is a condition when there is bicarbonate retention and hydrogen ion loss. Patients with evidence of volume depletion who are either normotensive or hypotensive are more likely to have metabolic alkalosis caused by chloride depletion. The college offers an uninspired answer in point form.
Nursing care plan these are general interventions for patients with metabolic alkalosis. Assessment of metabolic alkalosis diagnosis approach bmj. The following regimen is a bit agressive, yet proven to be safe among icu patients in the diabolo study. Primary metabolic alkalosis should be distinguished from metabolic compensation to respiratory acidosis. Metabolic acidosis has adverse effects on a variety of body functions. Though adequate from a passtheexam technical standpoint, this does not satisfying for anybody who actually wants to understand why they are doing the things they are. Histamine h2receptor antagonists are im portant in the prevention, control, and acute treatment of chlorideresponsive metabolic alkalosis. Metabolic alkalosis resulting from nasogastric drainage is a well recognized and potentially serious clinical problem. Metabolic alkalosis is primary increase in bicarbonate hco 3. Assessment of metabolic alkalosis diagnosis approach. Understanding these generation and maintenance mechanisms helps direct appropriate intervention and correction of this disorder. Metabolic alkalosis is divided into three categories. May 30, 2011 we present a patient with endstage kidney disease receiving hemodialysis therapy who developed severe metabolic alkalosis secondary to vomiting.
A case report from japan describes a case of metabolic alkalosis and myoclonus induced by ingestion of antacid containing sodiumbicarbonateinamanwithpreexistingcerebrovascular disease. The cornerstone of treatment is the correction of existing depletions and the prevention of further losses. This can usually be reversed by treatment with a saline solution. Metabolic alkalosis is an acidbase imbalance characterized by excessive loss of acid or excessive gain of bicarbonate produced by an underlying pathologic disorder. Metabolic alkalosis causes metabolic, respiratory, and renal responses, producing characteristic symptoms. Jan 17, 2018 metabolic alkalosis is a disorder where the primary defect, an increase in plasma bicarbonate concentration, leads to an increase in systemic ph. It has been mentioned that concomitant metabolic alkalosis from combined effects of volume contraction and vomiting or respiratory alkalosis from alcohol withdrawal, pain, high temperature, liver disease, sepsis or pregnancy may lead to a normal or even elevated arterial ph in. Metabolic alkalosis is a a primary acidbase disorder that causes the plasma bicarbonate to rise to an abnormally high level. The causes of metabolic alkalosis are gastrointestinal hydrogen and chloride loss and due to renal cause. Aug 15, 2019 metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. Metabolic alkalosis is characterized by a primary rise in the plasma bicarbonate concentration, which leads to an increase in arterial ph. Metabolic alkalosis most commonly results from severe cases of vomiting that cause you to lose the acidic fluids in your stomach. Most commonly used diuretic for metabolic alkalosis and perhaps the most effective.
Metabolic alkalosis american society of nephrology. Treatment of severe metabolic alkalosis in a patient with. This is a potential treatment of metabolic alkalosis among patients with renal. Metabolic alkalosis nursing management and interventions.
In the case of vomiting, administer antiemetics, if possible. Prevention and management of metabolic alkalosis beth s. An algorithmic approach to the workup and management of metabolic alkalosis is detailed in fig. Compensatory mechanisms include slow, shallow respirations to increase co 2 level and an increase of. The state of metabolic alkalosis is defined as a primary hydrogen. Metabolic alkalosis endocrine and metabolic disorders msd. Treatment of metabolic alkalosis with intravenous infusion of. Metabolic alkalosis is a common complication of congestive heart failure chf and its treatment with diuretics. Recreational drug use is becoming increasingly common among the patient population with as many as 20% of all acute medical admissions identi. Two factors are required for the genesis and then maintenance of metabolic alkalosis. If the cause is clear, such as a history of vomiting, nasogastric suction, or diuretic use, the appropriate management is. Cimetidine in the management of metabolic alkalosis. The metabolic alkalosis was severe in this patient, as were the hypokalemia and the adaptive or secondary. Jun 17, 2020 in this article, we will discuss various common causes of metabolic alkalosis.
An understanding of the diagnosis and treatment of entities that cause metabolic. Severe metabolic alkalosis in a hemodialysis patient. Pathophysiology, evaluation and management of metabolic. Question 4 from the second paper of 2006 asks the candidates to discuss the management of metabolic alkalosis. In the postoperative patient with acute renal failure, the management of the metabolic alkalosis is particularly difficult, and established modalities of therapy are sometimes ineffective and can be hazardous to the patient. Its occurrence is not mentioned in several recently publ. Lab values associated with metabolic alkalosis or going to be a high ph and a high bicarb level, as well as a positive high base excess. This strategy will lead to nahco3 diuresis and the restoration of the acidbase balance. Causes of metabolic alkalosis include diuretics, secretory adenoma of the colon, emesis, hyperaldosteronism, cushings syndrome, and exogenous steroids. Metabolic alkalosis defined by the increase of both plasma hco3 level 26 mmoll and blood arterial ph 7.
Treatment of metabolic alkalosis is based on the elimination of generation and maintenance factors, chloride and potassium repletion. The major decision point in making the diagnosis is based on volume status and blood pressure. Metabolic alkalosis is a very commonly encountered acidbase disorder that may be generated by a variety of exogenous andor endogenous, pathophysiologic mechanisms. Jan 01, 2019 metabolic alkalosis, either as a primary disturbance or as renal compensation of hypercapnia, occurs in about 25% of critically ill patients and may contribute to overly prolonged mechanical ventilation and high patient mortality reaching 80% with a ph 7. Common causes include prolonged vomiting, hypovolemia, diuretic use, and hypokalemia.
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