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Metabolic AlkalosisWhat is Metabolic Alkalosis ?Metabolic alkalosis is always secondary to an underlying cause and is marked by decreased amounts of acid or increased amounts of base bicarbonate. It's usually associated with hypocalcemia and hypokalemia, which may account for signs and symptoms. With early diagnosis and prompt treatment, the prognosis is good. Untreated metabolic alkalosis may be fatal. Causes of Metabolic AlkalosisMetabolic alkalosis results from the loss of acid or the increase of base. Causes of acid loss include vomiting, nasogastric (NG) tube drainage or lavage without adequate electrolyte replacement, fistulas, and the use of steroids and certain diuretics (furosemide, thiazides, and ethacrynic acid). Hyperadrenocorticism is another cause of severe acid loss. Cushing's disease, primary hyperaldosteronism, and Bartter's syndrome all lead to sodium retention and chloride and urinary loss of potassium and hydrogen. Excessive retention of base can result from excessive intake of bicarbonate of soda or other antacids (usually for treatment of gastritis or peptic ulcer), excessive intake of absorbable alkali (as in milk-alkali syndrome, often seen in patients with peptic ulcers), administration of excessive amounts of I.V. fluids with high concentrations of bicarbonate or lactate, massive blood transfusions, or respiratory insufficiency.Signs & Symptoms of Metabolic AlkalosisIn cases of metabolic alkalosis, slowed breathing may be an initial symptom. The patient may have episodes of apnea that may go on 15 seconds or longer. Cyanosis, a bluish or purplish discoloration of the skin, may also develop as a sign of inadequate oxygen intake. Nausea, Vomiting, Diarrhea may also occur. Other symptoms can include irritability:
Diagnostic TestsArterial blood gas analysis may reveal a blood pH over 7.45 and a bicarbonate level over 29 mEq/L in metabolic alkalosis. A partial pressure of carbon dioxide over 45 mm Hg indicates attempts at respiratory compensation. Serum electrolyte studies usually show low potassium, calcium, and chloride levels in metabolic alkalosis. Electrocardiogram (ECG) findings disclose a low T wave merging with a P wave and atrial or sinus tachycardia.TreatmentCorrecting the underlying cause of metabolic alkalosis is the goal of treatment. Mild metabolic alkalosis generally requires no treatment. Rarely, therapy for severe alkalosis includes cautious I.V. administration of ammonium chloride to release hydrogen chloride and restore ECF concentration and chloride levels. Potassium chloride and normal saline solution (except with heart failure) are usually sufficient to replace losses from gastric drainage. Electrolyte replacement with potassium chloride and discontinuing diuretics correct metabolic alkalosis resulting from potent diuretic therapy.Prevention TipsPatients receiving tube feedings or intravenous feedings must be monitored to prevent an imbalance of fluids and salts, particularly potassium, sodium, and chloride. Overuse of some drugs, including diuretics, laxatives, and antacids, should be avoided. |
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