Metabolic Alkalosis

Metabolic Alkalosis is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Development of a persistent metabolic alkalosis requires both generation (an inciting cause) and maintenance (a persistent impairment of the corrective renal response).
  • Generation often occurs with a primary increase in the plasma Descriptive text is not available for this image and may be due to either Descriptive text is not available for this image gain from alkali administration or, more commonly, excessive H+ loss. The latter may result from the loss of H+-rich fluids, including upper GI secretions. Contraction alkalosis refers to the contraction of volume around a fixed content of bicarbonate.
  • Maintenance requires a concomitant impairment in renal Descriptive text is not available for this image excretion because the kidney normally has a large capacity to excrete Descriptive text is not available for this image. This occurs as a result of a decreased glomerular filtration rate or enhanced tubular Descriptive text is not available for this image reabsorption from chloride depletion, volume contraction, and hypokalemia. A decrease in filtered chloride is sensed by the macula densa and, as a result of tubuloglomerular feedback, reduces filtered Descriptive text is not available for this image and stimulates aldosterone release. It also limits adaptive distal Descriptive text is not available for this image secretion. Metabolic alkalosis is often described as being chloride responsive or chloride unresponsive.

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General Principles

  • Development of a persistent metabolic alkalosis requires both generation (an inciting cause) and maintenance (a persistent impairment of the corrective renal response).
  • Generation often occurs with a primary increase in the plasma Descriptive text is not available for this image and may be due to either Descriptive text is not available for this image gain from alkali administration or, more commonly, excessive H+ loss. The latter may result from the loss of H+-rich fluids, including upper GI secretions. Contraction alkalosis refers to the contraction of volume around a fixed content of bicarbonate.
  • Maintenance requires a concomitant impairment in renal Descriptive text is not available for this image excretion because the kidney normally has a large capacity to excrete Descriptive text is not available for this image. This occurs as a result of a decreased glomerular filtration rate or enhanced tubular Descriptive text is not available for this image reabsorption from chloride depletion, volume contraction, and hypokalemia. A decrease in filtered chloride is sensed by the macula densa and, as a result of tubuloglomerular feedback, reduces filtered Descriptive text is not available for this image and stimulates aldosterone release. It also limits adaptive distal Descriptive text is not available for this image secretion. Metabolic alkalosis is often described as being chloride responsive or chloride unresponsive.

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