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Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate ( HCO − 3 ), or alternatively a direct result of increased bicarbonate concentrations.
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Metabolic alkalosis can be caused by repeated vomiting, [2] resulting in a loss of hydrochloric acid in the stomach contents. Severe dehydration, and the consumption of alkali, [3] are other causes. It can also be caused by administration of diuretics [2] and endocrine disorders such as Cushing's syndrome.
An elevated anion gap metabolic acidosis and ketosis is the classic present. [3] However, a mixed acid-base disorder may be present especially if vomiting is contributing to a hypochloremic alkalosis. [2] The ketone which is present is mostly beta-hydroxybutyrate rather than acetoacetate resulting in only a weakly positive nitroprusside test. [2]
In addition to respiratory failure and accidents caused by its effects on the central nervous system, alcohol causes significant metabolic derangements. Hypoglycaemia occurs due to ethanol's inhibition of gluconeogenesis , especially in children, and may cause lactic acidosis , ketoacidosis , and acute kidney injury .
Alcohol dehydrogenase instead enzymatically converts ethanol to acetaldehyde, a less toxic organic molecule. [ 15 ] [ 20 ] Additional treatment may include sodium bicarbonate for metabolic acidosis, and hemodialysis or hemodiafiltration to remove methanol and formate from the blood. [ 15 ]
Milk-alkali syndrome is an illness that is characterized by hypercalcaemia, kidney damage, and metabolic alkalosis. [17] This syndrome was discovered in the early 1900s when people began experiencing adverse effects from Bertrand Sippy's gastric ulcer treatment consisting of milk and alkali.
Laxative abuse can mimic the serum electrolyte abnormalities, but fractional excretion of potassium will be low; Diuretic abuse could be suspected if urinary chloride excretion varies by time of day but may require a diuretic assay to detect; Surreptitious vomiting can cause metabolic alkalosis and hypokalaemia, but urinary chloride levels will ...