Metabolic alkalosis quick hits

Question 1

What are the two types of metabolic alkalosis?

Answer 1

Chloride responsive
+
Chloride NON-responsive

Chloride responsive will have low urinary chloride

Chloride non-responsive will have high urinary chloride

Question 2

What causes 80% of metabolic alkalosis?

Answer 2

FUROSEMIDE

Next = VOMITING

Other causes:
Sodium bicarbonate therapy
Glucocorticoid excess
hydro/fludrocortisone
Laxative abuse
Diarrhoea (predominant small bowel)

Question 3

Name 2 things that would differentiate RTA 1 from 2

Answer 3

RTA 1 = urine mOSm <150

RTA 2 = Glucosuria + mOSm >150

RTA 1+2 have hypokalaemia
RTA 4 = hyperkalaemia

Question 4

What is RTA 4 and what causes it?

Answer 4

RTA 4 is caused two main mechanisms:

1. adrenal insufficiency e.g. addisons/FWH
2. Renin deficiency from JGM - HTN most common cause also T2DM

Hyperkalaemia with low normal bicarb

Question 5

What drugs can cause low renin?

Answer 5

NSAIDS!
Beta-blockers
Tacrolimus

Question 6

What drugs can cause low aldosterone synthesis?

Answer 6

Heparin
ACE-I/ARBs