Metabolic Alkalosis

Question 1

How Metabolic Alk develops if kidneys can excrete lots of bicarb?

Answer 1

V depletion -> aldosterone and hypokalemia necessary to maintain

Question 2

ENAC

Answer 2

Required for alk/hypokal effect of aldosterone

Question 3

Redistribution Alkalosis

Answer 3

Hypokal causes shift of protons into cell making EC space alkalotic, but cells acidic so they think they need to secrete more H+. Increased ammoniagenesis (PT), increased sec H+ (DT)

Question 4

Tx for V Depletion (upper GI loss) Alkalosis

Answer 4

IV NS, maybe some KCl supplementation, bc caused by V depletion, secondary hyperaldosteronism, and hypokal

Question 5

Urine Na in V Depletion Alk

Answer 5

HCO3- excr w/ cation, so kidney trying to reab Na but can’t do it fully. HCO3- pulls some out, so Na in urine doesn’t look low. Instead do Urine Cl

Question 6

Chloride Responsive Metabolic Alkalosis/Contraction Alkalosis

Answer 6

Upper GI loss, lose Cl, so body trying to restore and will drop below 25 in V depletion. Respond to 0.9 NS (bc that has Cl in it too). V mediated

Question 7

Chloride Unresponsive Metabolic Alkalosis

Answer 7

Urine Cl > 40. Hormone mediated, Something like adrenal hyperplasia/cushing/s/licorice/renal a. stenosis causing chronic release of aldosterone/hyperkal. Almost always associated to HTN from constant conserving mechs

Question 8

3 Congenital Syndromes of Chloride Unresponsive Alk

Answer 8

Bartter’s
Gitelman’s
Liddle’s

Question 9

Liddle’s Syndrome

Answer 9

Overreactive ENAC channel from AD GoF mut, so CT reabs too much Na and shit. Low aldosterone levels depsite pseudohyperaldosteronism
Treat w/ K sparing diuretics (Amiloride)

Question 10

Bartter’s Syndrome

Answer 10

AR defect in NK2CC in TAL, so just like loop diuretic and lose salt. High aldosterone levels. May be related to muts that cause high PGs, so tx is PGis***

Question 11

Gittelman’s Syndrome

Answer 11

AR defect in Na-Cl cotransporter in DT, so acts like a thiazide diuretic and causes NaCl loss w/ hypokalemia. Maybe prescribe anti-ald shit or K sparing dius?

Question 12

Exception: 1 Chloride Responsive Metabolic Alkalosis w/ Urine Cl > 40

Answer 12

Diuretic therapy (LADs or thiazide), cause and increase Na and Cl excretion, but will respond to saline

Question 13

Metabolic Alkalosis w/ Retention of Alkali

Answer 13

Milk-Alkali syndrome - lots of alkali in diet from milk w/ pts with peptic ulcer disease
Now like w/ Tums and CaCO3, hypercalc and metabolic alk