Metabolic alkalosis diagnostic study of choice: Difference between revisions

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{{Metabolic alkalosis}}
{{Metabolic alkalosis}}
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{{CMG}}; {{AE}} {{MMT}}
== Overview ==
== Overview ==
Arterial Blood Gas Analysis(ABG) is gold standard for diagnosis of Metabolic Alkalosis. Other laboratory tests, for instance Basic metabolic panel, serum aldosterone, serum renin, Urine analysis, urine pH, Urine chloride and sodium, Chest X-ray, Abdominal USG/CT are done to rule out the causes of metabolic alkalosis. 


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The following result of ABG is confirmatory of Metabolic Alkalosis:
* The following result of [gold standard test] is confirmatory of [disease name]:
** Blood pH is elevated more than 7.45.
** Result 1
** Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter.
** Result 2
**Partial pressure of CO2 reduces to combat elevated bicarbonate.
* The [name of the investigation] should be performed when:
 
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* The diagnostic study of choice for [disease name] is [name of the investigation].
* There is no single diagnostic study of choice for the diagnosis of [disease name].  
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of Metabolic Alkalosis, the ABG is the most efficient test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison of various diagnostic studies for [disease name] ====
==== The comparison of various diagnostic studies for Metabolic alkalosis ====
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #696969; color: #FFFFFF; text-align: center;" |[[ABG]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |<100%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background: #696969; color: #FFFFFF; text-align: center;" |[[Central VBG]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |100%
|}
|}
<small> ✔= The best test based on the feature </small>


<ref name="pmid29649820">{{cite journal |vauthors=Schrauben SJ, Negoianu D, Costa C, Cohen RM, Goldfarb S, Fuchs BD, Berns JS |title=Accuracy of Acid-Base Diagnoses Using the Central Venous Blood Gas in the Medical Intensive Care Unit |journal=Nephron |volume=139 |issue=4 |pages=293–298 |date=2018 |pmid=29649820 |pmc=6067967 |doi=10.1159/000488501 |url=}}</ref>
===== Diagnostic results =====
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
The following result of Arterial blood gas analysis is confirmatory of Metabolic Alkalosis:
* Result 1
** Blood pH is elevated more than 7.45.
* Result 2
** Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter.
**Partial pressure of CO2 reduces to combat elevated bicarbonate.
 


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
The various investigations must be performed in the following order:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
 
* A positive [test] is detected in the patient, to confirm the diagnosis.
**ABG
**Basic metabolic panel
**Serum aldosterone
**Serum renin
**Urine analysis, Urine pH
**Urine chloride and sodium
**Chest X-ray
**Abdominal USG/CT
**Central VBG
**Genetic Testing


=== Diagnostic Criteria ===
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
* The diagnosis of Metabolic Alkalosis is based on the laboratory diagnosis, which includes:
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
** Blood pH is elevated more than 7.45.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
** Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
**Partial pressure of CO2 reduces to combat elevated bicarbonate.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].
 


==References==
==References==

Latest revision as of 05:08, 25 February 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

Overview

Arterial Blood Gas Analysis(ABG) is gold standard for diagnosis of Metabolic Alkalosis. Other laboratory tests, for instance Basic metabolic panel, serum aldosterone, serum renin, Urine analysis, urine pH, Urine chloride and sodium, Chest X-ray, Abdominal USG/CT are done to rule out the causes of metabolic alkalosis.

Diagnostic Study of Choice

Study of choice

  • The following result of ABG is confirmatory of Metabolic Alkalosis:
    • Blood pH is elevated more than 7.45.
    • Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter.
    • Partial pressure of CO2 reduces to combat elevated bicarbonate.
  • Investigations:
    • Among patients who present with clinical signs of Metabolic Alkalosis, the ABG is the most efficient test for diagnosis.

The comparison of various diagnostic studies for Metabolic alkalosis

Test Sensitivity Specificity
ABG <100% <100%
Central VBG 100% 100%

[1]

Diagnostic results

The following result of Arterial blood gas analysis is confirmatory of Metabolic Alkalosis:

    • Blood pH is elevated more than 7.45.
    • Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter.
    • Partial pressure of CO2 reduces to combat elevated bicarbonate.


Sequence of Diagnostic Studies

The various investigations must be performed in the following order:

    • ABG
    • Basic metabolic panel
    • Serum aldosterone
    • Serum renin
    • Urine analysis, Urine pH
    • Urine chloride and sodium
    • Chest X-ray
    • Abdominal USG/CT
    • Central VBG
    • Genetic Testing

Diagnostic Criteria

  • The diagnosis of Metabolic Alkalosis is based on the laboratory diagnosis, which includes:
    • Blood pH is elevated more than 7.45.
    • Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter.
    • Partial pressure of CO2 reduces to combat elevated bicarbonate.

References

  1. ↑ Schrauben SJ, Negoianu D, Costa C, Cohen RM, Goldfarb S, Fuchs BD, Berns JS (2018). "Accuracy of Acid-Base Diagnoses Using the Central Venous Blood Gas in the Medical Intensive Care Unit". Nephron. 139 (4): 293–298. doi:10.1159/000488501. PMC 6067967. PMID 29649820.

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