User menu

Accès à distance ? S'identifier sur le proxy UCLouvain

The patient with metabolic alkalosis

Primary tabs

Gillion, Valentine [UCL] Jadoul, Michel [UCL] Devuyst, Olivier [UCL] Pochet, Jean-Michel [UCL]

(eng) Metabolic alkalosis defined by the increase of both plasma HCO3- level (>26 mmol/L) and blood arterial pH (>7.43) is quite frequent and usually accompanied by hypokalemia. Its pathogenesis requires both the generation of alkalosis and its maintenance. Generation may be due to excessive hydrogen ion loss by the gastrointestinal tract (e.g. vomiting) or by the kidney (e.g. use of loop diuretics) or may be due to exogenous base gain. Maintenance reflects the inability of the kidney to excrete the excess of bicarbonate because of hypovolemia, chloride depletion, hypokalemia, hyperaldosteronism, renal failure or a combination of these factors. The evaluation of volemic status and measurement of urinary Cl- and plasma levels of renin and aldosterone are crucial to identify the cause(s) of metabolic alkalosis. The cornerstone of treatment is the correction of existing depletions and the prevention of further losses. In vomiting-induced chloride depletion alkalosis, infusion of potassium chloride restores the excretion of bicarbonate by the kidney.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès interdit
Publication date 2019
Language Anglais
Journal information "Acta Clinica Belgica" - Vol. 74, no. 1, p. 34-40 (2019)
Peer reviewed yes
Publisher Taylor & Francis ((United Kingdom) London)
issn 1784-3286
e-issn 2295-3337
Publication status Publié
Affiliations UCL - SSS/IREC/NEFR - Pôle de Néphrologie
UCL - (SLuc) Service de néphrologie
Keywords General Medicine ; Metabolic alkalosis ; Acid base disturbances
Links
  1. Petit Pierre-Florent, Hantson Philippe, Jadoul Michel, Gillion Valentine, The Case | Severe hypokalemia complicated by a syncope, 10.1016/j.kint.2017.12.009
  2. Pochet J.-M., Laterre P.-F., Jadoul M., Devuyst O., METABOLIC ALKALOSIS IN THE INTENSIVE CARE UNIT, 10.1179/acb.2001.002
  3. HODGKIN JOHN E., SOEPRONO FRED F., CHAN DAVID M., Incidence of metabolic alkalemia in hospitalized patients : , 10.1097/00003246-198012000-00005
  4. ANDERSON LEE E., HENRICH WILLIAM L., Alkalemia-associated Morbidity and Mortality in Medical and Surgical Patients : , 10.1097/00007611-198706000-00016
  5. Van Goidsenhoven GM, Clin Sci, 13, 383 (1954)
  6. Li K, Int J Clin Exp Med, 8, 6578 (2015)
  7. Diskin Charles J., Stokes Thomas J., Dansby Linda M., Radcliff Lautrec, Carter Thomas B., Recurrent metabolic alkalosis and elevated troponins after crack cocaine use in a hemodialysis patient, 10.1007/s10157-006-0414-y
  8. Patel A. M., Goldfarb S., Got Calcium? Welcome to the Calcium-Alkali Syndrome, 10.1681/asn.2010030255
  9. Seldin Donald W., Tarail Robert, THE METABOLISM OF GLUCOSE AND ELECTROLYTES IN DIABETIC ACIDOSIS 1, 10.1172/jci102293
  10. Kakajiwala A, Case Rep Nephrol, 2017, 6582613 (2017)
  11. Babior Bernard M., Villous adenoma of the colon, 10.1016/0002-9343(66)90223-3
  12. Plawker Marc W., Rabinowitz Simon S., Etwaru Dhanan J., Glassberg Kenneth I.*, Hypergastrinemia, Dysuria-Hematuria and Metabolic Alkalosis: Complications Associated with Gastrocystoplasty, 10.1016/s0022-5347(01)67107-6
  13. Wedenoja Satu, Pekansaari Elina, Höglund Pia, Mäkelä Siru, Holmberg Christer, Kere Juha, Update on SLC26A3 mutations in congenital chloride diarrhea, 10.1002/humu.21498
  14. Dussol Bertrand, Équilibre acidobasique : acidoses et alcaloses métaboliques, 10.1016/j.nephro.2014.05.004
  15. Pedroli Gianluca, Liechti-Gallati Sabina, Mauri Simonetta, Birrer Peter, Kraemer Richard, Foletti-Jäggi Claudia, Bianchetti Mario G., Chronic Metabolic Alkalosis: Not Uncommon in Young Children with Severe Cystic Fibrosis, 10.1159/000168839
  16. Stone D K, Seldin D W, Kokko J P, Jacobson H R, Mineralocorticoid modulation of rabbit medullary collecting duct acidification. A sodium-independent effect., 10.1172/jci110986
  17. Galla J, J Am Soc Nephrol, 11, 369 (2000)
  18. Palmer BF, J Am Soc Nephrol, 8, 1462 (1997)
  19. Ardhanari Sivakumar, Kannuswamy Rohini, Chaudhary Kunal, Lockette Warren, Whaley-Connell Adam, Mineralocorticoid and Apparent Mineralocorticoid Syndromes of Secondary Hypertension, 10.1053/j.ackd.2015.03.002
  20. Zennaro Maria-Christina, Boulkroun Sheerazed, Fernandes-Rosa Fabio, Inherited forms of mineralocorticoid hypertension, 10.1016/j.beem.2015.04.010
  21. Levitin Howard, Branscome William, Epstein Franklin H., The Pathogenesis Of Hypochloremia in Respiratory Acidosis1, 10.1172/jci103758
  22. Brunner F. P., Frick P. G., Hypokalaemia, Metabolic Alkalosis, and Hypernatraemia due to "Massive" Sodium Penicillin Therapy, 10.1136/bmj.4.5630.550
  23. Hoorn E. J., Zietse R., Severe hypokalaemia caused by flucloxacillin, 10.1093/jac/dkn117
  24. Cui Yunying, Tong Anli, Jiang Jun, Wang Fen, Li Chunyan, Liddle syndrome: clinical and genetic profiles, 10.1111/jch.12949
  25. Geara Abdallah S., Parikh Amay, Rekhtman Yelena, Rao Maya K., The Case ∣ Metabolic alkalosis in a patient with cystic fibrosis, 10.1038/ki.2011.400
  26. Wall Susan M., Lazo-Fernandez Yoskaly, The Role of Pendrin in Renal Physiology, 10.1146/annurev-physiol-021014-071854
  27. Luke R. G., Galla J. H., It Is Chloride Depletion Alkalosis, Not Contraction Alkalosis, 10.1681/asn.2011070720
  28. Kassirer Jerome P., London Abram M., Goldman David M., Schwartz William B., On the pathogenesis of metabolic alkalosis in hyperaldosteronism, 10.1016/s0002-9343(70)80021-3
  29. Kassirer Jerome P., Schwartz William B., The response of normal man to selective depletion of hydrochloric acid, 10.1016/0002-9343(66)90182-3
  30. Lisawat Panupong, Gennari F. John, Approach to the Hemodialysis Patient With an Abnormal Serum Bicarbonate Concentration, 10.1053/j.ajkd.2013.12.017
  31. Fall Pamela, Szerlip Harold M., Continuous Renal Replacement Therapy: Cause and Treatment of Electrolyte Complications : CRRT AND ELECTROLYTES, 10.1111/j.1525-139x.2010.00790.x
  32. Martin WJ, Clin Pharm, 1, 42 (1982)
  33. Knutsen OlavH., NEW METHOD FOR ADMINISTRATION OF HYDROCHLORIC ACID IN METABOLIC ALKALOSIS, 10.1016/s0140-6736(83)92081-0
  34. Buchanan Ian B., Campbell Brendan T., Peck Michael D., Cairns Bruce A., Chest Wall Necrosis and Death Secondary to Hydrochloric Acid Infusion for Metabolic Alkalosis : , 10.1097/01.smj.0000172781.27664.87
Bibliographic reference Gillion, Valentine ; Jadoul, Michel ; Devuyst, Olivier ; Pochet, Jean-Michel. The patient with metabolic alkalosis. In: Acta Clinica Belgica, Vol. 74, no. 1, p. 34-40 (2019)
Permanent URL http://hdl.handle.net/2078.1/204528