IM
Metabolic Alkalosis:
- Increase PH and Increase HCO3 if compensation started CO2 is also increase.
- Fixed by respiration (metabolic).
Causes:
-
Saline sensitive (dehydration patient) + low cl in urin:
- Vomiting
- NG tube
- Diuretics - thiazides & sulph (all except acctazolamide spirino (carbonic anhydrase inhibitor)
- Antacids treated by saline.
-
Saline resistant: (already have fluid expansion ) + increase Cl
- Cushing syndrome (hyper aldosteronism): patients have salt and water retention. - hydrogen loss (hypokalemic metabolic alkalosis)
- Liddles diseases - (normal aldosterone, high amount receptors ?cc) - (hypokalemic metabolic alkalosis)
- Conn’s syndrome
- Renal artery stenosis Don’t give saline.
Clinical features:
- Increase total peripherals resistance--- vasoconstriction (unlike acidosis) (decreased H+?cc)
- Decrease RR (retention of Co2).
- Decrease k, ca , Mg.
- Altered mental status.
- Excitation of neurons :seizure and convulsions. Na+ depolarization w/ ca 2+ - when there is no depolarization result in increased excitation
carpopedal spasm carhbiski sign?CC
Treatment:
- Saline sensetive---saline.
- Saline resistance---- spironolactone and aldosterone reset or antagonist.
Pedia
Metabolic Alkalosis
A primary increase in plasma bicarbonate and an increase in plasma pH as a result of the following:
- Gastrointestinal loss, e.g., pyloric stenosis (hypochloremic hypokalemic metabolic alkalosis)
- Congenital chloride diarrhea
- Furosemide therapy
- Cystic fibrosis
- Bartter syndrome
- Hyperaldosteronism
- Excess intake of base, e.g., excess ingestion of antacid medicine (rare in childhood)