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Treatment of metabolic alkalosis

INTRODUCTION

Metabolic alkalosis is characterized by a primary rise in the plasma bicarbonate concentration which leads to an increase in arterial pH. Two factors are required for the genesis and then maintenance of metabolic alkalosis: a process that raises the plasma bicarbonate concentration, and a process that prevents excretion of the excess bicarbonate in the urine [1,2]. Treatment of metabolic alkalosis should be aimed at reversing these two factors.

This topic will provide a brief overview of the pathogenesis of metabolic alkalosis followed by a discussion of how to treat affected patients. The pathogenesis of metabolic alkalosis is reviewed in more detail elsewhere. (See "Pathogenesis of metabolic alkalosis".)

The etiology and evaluation of patients with metabolic alkalosis are discussed separately. (See "Causes of metabolic alkalosis" and "Clinical manifestations and evaluation of metabolic alkalosis".)

OVERVIEW OF THE PATHOGENESIS

Two factors are required for the genesis and then maintenance of metabolic alkalosis: a process that raises the plasma bicarbonate concentration, and a process that prevents excretion of the excess bicarbonate in the urine [1,2].

Factors that increase plasma bicarbonate — The most common mechanisms for a primary increase in the plasma bicarbonate concentration are as follows (table 1) (see "Causes of metabolic alkalosis"):

             

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Literature review current through: Oct 2014. | This topic last updated: Jan 2, 2013.
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References
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