metabolic alkalosis Flashcards
what are the main causes associated with metabolic alkalosis ?
GI acid loss
contraction alkalosis - loss of fluid but not equally in terms of salt and acid
what are the methods of GI acid loss ?
vomiting and gastric suction
what are the classic features associated with GI acid loss ?
hypochloremia
hypokalemia
hyochloremic , hypokalemic metabolic alkalosis
what electrolyte imbalance is associated with metabolic alkalosis ?
hypokalemia
what is contraction alkalosis ?
vascular volume decreased ? means loss of NA and CL
so effective circulating volume decreases
this activates the RAAS
activates SNS
allows for HCO3 resorption in the proximal tubule
increasing hydrogen secretion in the collecting duct
what are the causes of contraction alkalosis ?
vomiting
diuretics ( which also cause hypokalemia)
heart failure
cirrohsis due to treatment with diuretics
what drugs specifically are associated with causing metabolic alkalosis ?
loop and thiazide diuretics
what are the causes of hyperaldosteronism ?
adrenal overproduction of aldosterone
adrenal hyperplasia
adrenal adenoma ( conns syndrome )
what is the association between metabolic alkalosis and hyperaldosteronism ?
the over production of aldosterone causes hypokalemia
which in turn causes metabolic alkalosis
what is the triad of milk alkali syndrome ?
hypercalcemia
metabolic alkalosis
renal failure
what are the causes of milk alkali syndrome ?
excessive intake of calcium and alkali
usually due to the excessive intake of calcium carbonate or milk
often associated with patients who suffer from dyspepsia
what is bartter syndrome ?
it is a resorption defect in the thick ascending loop of henle ( no sodium resorption ka2eni ba5od diuretics ) hence the hypokalemia
associated with metabolic alkalsosis
what is gitelmans syndrome ?
also happens in children associated with lack of sodium resorption in the DCT hence gives the same effect as being on a diuretic and so cause hypokalemia and metabolic alkalosis
less severe than bartter
what are the distinguishing features of barter syndrome ?
high urinary calcium in contrast to gitelman , urinary calcium is low
what is gitelman syndrome similar to administrating ?
thiazide diuretics
what is liddle syndrome ?
increased activity of ENaC due to genetic mutation
presents similarly to hyperaldosteronism
young patinet with hypokalemia, hypertension
aldosterone levels are low
what is the treatment for liddle syndrome ?
amiloridem - a potassium sparing diuretic that blocks the Enac
what is SAME ?
syndrome of apparent mineralocorticoid excess associated with deficiency of the enzyme 11β-hydroxysteroid dehydrogenase type 2
aldosterone levels will be low
what is the treatment of SAME ?
potassium sparing diuretic
dexamethasone
when thinking about the causes of metabolic alkalosis what is the first thing u need to ask ?
hypertensive or not
if no - think gittleman and barter
if yes think of things due to the effect of aldosterone
high ald ? hyperald
low ALD ? liddle SAME or licorice
why would we measure urinary chloride in metabolic alkalosis ?
due to gastric acid loss if we find urinary chloride
what are the chloride responsive forms of metabolic alkalosis ?
due to diuretics and vomiting
what is the normal compensatory mechanism for metabolic alkalsosis ?
hypoventilation
