Alkalosis Due to Metabolism: Triggers, Indicators, and Care Strategies
Metabolic alkalosis is a condition where the body's chemistry becomes too alkaline, with elevated levels of bicarbonate in the blood. This article aims to explain two types of metabolic alkalosis: chloride-responsive and chloride-resistant.
Chloride-Responsive Metabolic Alkalosis
Chloride-responsive metabolic alkalosis is commonly caused by conditions that result in chloride loss, such as prolonged vomiting, diuretic use, or chloride-rich diarrhea (like congenital chloride diarrhea). This leads to volume depletion and loss of gastric acid, causing increased bicarbonate retention. Symptoms include muscle cramps, weakness, confusion, and seizures, often related to associated hypokalemia and hypocalcemia.
Chloride-Resistant Metabolic Alkalosis
Chloride-resistant metabolic alkalosis typically arises from conditions with excess mineralocorticoid activity, such as primary hyperaldosteronism, Cushing's syndrome, or genetic disorders like Liddle syndrome. Here, there is sodium retention with chloride loss that is not correctable by chloride administration. Patients may present with hypertension, hypokalemia, muscle weakness, and metabolic alkalosis that does not improve with saline.
Both types may show elevated serum bicarbonate and pH, hypokalemia, and symptoms related to electrolyte imbalances and volume status.
Reduced effective arterial blood volume due to heart or liver conditions can contribute to metabolic alkalosis. Potassium deficiency, stomach acid loss, genetic causes such as cystic fibrosis, Gitelman syndrome, and Bartter's syndrome can also contribute. Dehydration, conditions that affect the kidneys, and certain medications can lead to electrolyte imbalances, potentially causing metabolic alkalosis.
Heart, kidney, or liver failure can affect how well the body eliminates carbon dioxide and balances electrolytes, potentially leading to metabolic alkalosis. Diuretics such as hydrochlorothiazide and furosemide increase urine production and promote sodium loss, potentially leading to metabolic alkalosis.
In severe cases, metabolic alkalosis can cause the body to bind more calcium, leading to symptoms such as headache, lethargy, weakness, disorientation, seizures, and coma. Metabolic alkalosis can cause life-threatening problems in severe cases, such as low calcium levels leading to seizures or coma.
It's important to note that metabolic alkalosis can be divided into two categories: chloride-responsive alkalosis and chloride-resistant alkalosis. Treatment for each type may involve IV fluids, activated charcoal, and medications to treat symptoms.
References: [1] Goldschmidt, S. (2019). Clinical Diagnosis and Management by Laboratory Methods. 25th edition. Elsevier. [2] Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2019). Harrison's Principles of Internal Medicine. 20th edition. McGraw-Hill Education. [3] Katzung, B. G. (2020). Basic and Clinical Pharmacology. 14th edition. McGraw-Hill Education.
- Science has made significant strides in understanding metabolic disorders, including metabolic alkalosis.
- Chloride-responsive metabolic alkalosis is a common result of conditions causing chloride loss in the body.
- Prolonged vomiting, diuretic use, and chloride-rich diarrhea are significant causes of chloride-responsive metabolic alkalosis.
- This condition leads to volume depletion and loss of gastric acid, causing increased bicarbonate retention.
- Symptoms of chloride-responsive metabolic alkalosis include muscle cramps, weakness, confusion, and seizures.
- Chloride-resistant metabolic alkalosis typically arises from conditions with excess mineralocorticoid activity.
- Primary hyperaldosteronism, Cushing's syndrome, and genetic disorders like Liddle syndrome are examples of conditions causing chloride-resistant metabolic alkalosis.
- Here, there is sodium retention with chloride loss that is not correctable by chloride administration.
- Patients with chloride-resistant metabolic alkalosis may present with hypertension, hypokalemia, muscle weakness, and metabolic alkalosis that does not improve with saline.
- Both types of metabolic alkalosis may show elevated serum bicarbonate and pH, hypokalemia, and symptoms related to electrolyte imbalances and volume status.
- Reduced effective arterial blood volume due to heart or liver conditions can contribute to metabolic alkalosis.
- Potassium deficiency, stomach acid loss, genetic causes such as cystic fibrosis, Gitelman syndrome, and Bartter's syndrome can also contribute to metabolic alkalosis.
- Dehydration, conditions that affect the kidneys, and certain medications can lead to electrolyte imbalances, potentially causing metabolic alkalosis.
- Heart, kidney, or liver failure can affect how well the body eliminates carbon dioxide and balances electrolytes.
- Diuretics such as hydrochlorothiazide and furosemide increase urine production and promote sodium loss, potentially leading to metabolic alkalosis.
- In severe cases, metabolic alkalosis can cause the body to bind more calcium, leading to symptoms such as headache, lethargy, weakness, disorientation, seizures, and coma.
- Metabolic alkalosis can cause life-threatening problems in severe cases, such as low calcium levels leading to seizures or coma.
- It's important to note that metabolic alkalosis can be divided into two categories: chloride-responsive alkalosis and chloride-resistant alkalosis.
- Treatment for each type of metabolic alkalosis may involve IV fluids, activated charcoal, and medications to treat symptoms.
- Metabolic alkalosis is a medical-condition that falls under the broader category of chronic-diseases.
- Understanding and managing metabolic alkalosis is crucial for maintaining health-and-wellness in individuals with chronic-diseases.
- Fitness-and-exercise, good nutrition, and regular check-ups are essential for managing chronic-diseases like metabolic alkalosis.
- Climate-change can impact the health-and-wellness of individuals with chronic-diseases, including metabolic alkalosis, by altering access to healthy food options and impacting air quality.
- The manufacturing industry plays a significant role in climate-change, contributing to pollutants that can affect the health of individuals with chronic-diseases.
- Mental-health is also crucial in managing chronic-diseases like metabolic alkalosis, as stress and depression can exacerbate symptoms.
- Skin-care and therapies-and-treatments are essential for managing skin-conditions that may arise from chronic-diseases like metabolic alkalosis.
- Finance is a critical aspect of managing chronic-diseases like metabolic alkalosis, as costs for therapies, treatments, and medications can be high.
- Medicare, environmental-science, fitness-and-exercise, mental-health, skin-care, nutrition, and technology are all interconnected in the broader field of health-and-wellness, including the management of chronic-diseases like metabolic alkalosis.
