Treatment of metabolic alkalosis
- Ankit Mehta, MD
Ankit Mehta, MD
- Assistant Professor, Department of Internal Medicine, Texas A&M College of Medicine, Dallas
- Associate Program Director, Internal Medicine Residency, Baylor University Medical Center, Dallas
- Michael Emmett, MD
Michael Emmett, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Chief of Internal Medicine
- Baylor University Medical Center
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
The genesis and the maintenance of metabolic alkalosis are distinct processes. Initially, a process that raises the plasma bicarbonate concentration occurs, and then another process prevents excretion of the excess bicarbonate in the urine [1,2].
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jun 30, 2017.References
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- OVERVIEW OF THE PATHOGENESIS
- Factors that increase plasma bicarbonate
- Factors that impair bicarbonate excretion
- Treat the underlying cause
- Increase renal bicarbonate excretion
- - Reduced arterial or effective arterial blood volume and chloride depletion
- True volume depletion
- Edematous states
- Chloride depletion
- - Potassium depletion
- Treatment of posthypercapnic metabolic alkalosis
- Treatment of metabolic alkalosis with acute or chronic kidney disease
- Hydrochloric acid in selected patients
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS