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== Metabolic Alkalosis ==
== Metabolic Alkalosis ==
'''''Differential diagnosis of metabolic alkalosis is as follow''''':<ref name="pmid10665945">{{cite journal |vauthors=Galla JH |title=Metabolic alkalosis |journal=J. Am. Soc. Nephrol. |volume=11 |issue=2 |pages=369–75 |date=February 2000 |pmid=10665945 |doi= |url=}}</ref>
'''''Differential diagnosis of metabolic alkalosis is as follow''''':<ref name="pmid10665945">{{cite journal |vauthors=Galla JH |title=Metabolic alkalosis |journal=J. Am. Soc. Nephrol. |volume=11 |issue=2 |pages=369–75 |date=February 2000 |pmid=10665945 |doi= |url=}}</ref>
{| class="wikitable"
{|
! rowspan="4" |Category
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! colspan="2" rowspan="4" |Disease
! colspan="2" rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! colspan="4" rowspan="3" |Mechanism
! colspan="4" rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Mechanism
! colspan="6" |Clinical
! colspan="6" align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical
! colspan="12" |Paraclinical
! colspan="12" align="center" style="background:#4479BA; color: #FFFFFF;" + |Paraclinical
! rowspan="4" |Gold standard diagnosis
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Gold standard diagnosis
! rowspan="4" |Other findings
! rowspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Other findings
|-
|-
! colspan="3" rowspan="2" |Symptoms
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Symptoms
! colspan="3" rowspan="2" |Signs
! colspan="3" rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs
! colspan="12" |Lab data
! colspan="12" align="center" style="background:#4479BA; color: #FFFFFF;" + |Lab data
|-
|-
! colspan="3" |ABG
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |ABG
! colspan="5" |Chemistry
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Chemistry
!
!
! colspan="3" |Renal function
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Renal function
|-
|-
!Hydrogen loss
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hydrogen loss
!Accumulation of base
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Accumulation of base
!Chloride depletion
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Chloride depletion
!Mineralocorticoid excess
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mineralocorticoid excess
!Fever
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Fever
!Dyspnea
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dyspnea
!Edema
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Edema
!Toxic/ill
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Toxic/ill
!BP
! align="center" style="background:#4479BA; color: #FFFFFF;" + |BP
!Dehydration
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dehydration
!HCO<sub>3</sub><sup>−</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |HCO<sub>3</sub><sup>−</sup>
!paCO<sub>2</sub>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |paCO<sub>2</sub>
!O<sub>2</sub>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |O<sub>2</sub>
!Cl<sup>−</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cl<sup>−</sup>
!K<sup>+</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |K<sup>+</sup>
!Na<sup>+</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Na<sup>+</sup>
!Ca<sup>+</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ca<sup>+</sup>
!Mg<sup>+</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Mg<sup>+</sup>
!Renin
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Renin
!Bun
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Bun
!Cr
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cr
!Urine Cl<sup>−</sup>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Urine Cl<sup>−</sup>
|-
|-
| rowspan="3" |Exogenous HCO<sub><big>3</big></sub><sup>−</sup> loads
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Exogenous HCO<sub><big>3</big></sub><sup>−</sup> loads
| colspan="2" |Acute alkali administration<ref name="MáttarWeil1974">{{cite journal|last1=Máttar|first1=João A.|last2=Weil|first2=Max Harry|last3=Shubin|first3=Herbert|last4=Stein|first4=Leon|title=Cardiac arrest in the critically III|journal=The American Journal of Medicine|volume=56|issue=2|year=1974|pages=162–168|issn=00029343|doi=10.1016/0002-9343(74)90593-2}}</ref>
! colspan="2" align="center" style="background:#DCDCDC;" + |Acute alkali administration<ref name="MáttarWeil1974">{{cite journal|last1=Máttar|first1=João A.|last2=Weil|first2=Max Harry|last3=Shubin|first3=Herbert|last4=Stein|first4=Leon|title=Cardiac arrest in the critically III|journal=The American Journal of Medicine|volume=56|issue=2|year=1974|pages=162–168|issn=00029343|doi=10.1016/0002-9343(74)90593-2}}</ref>
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|−
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Revision as of 14:58, 17 May 2018

Metabolic Alkalosis

Differential diagnosis of metabolic alkalosis is as follow:[1]

Category Disease Mechanism Clinical Paraclinical Gold standard diagnosis Other findings
Symptoms Signs Lab data
ABG Chemistry Renal function
Hydrogen loss Accumulation of base Chloride depletion Mineralocorticoid excess Fever Dyspnea Edema Toxic/ill BP Dehydration HCO3− paCO2 O2 Cl− K+ Na+ Ca+ Mg+ Renin Bun Cr Urine Cl−
Exogenous HCO3− loads Acute alkali administration[2] − + − − - + - + ↓ ↓ ↑ ↑ ↓ ↓ ↓ ↓ ↑ Nl
Milk−alkali syndrome - + - + -
Transfusion +
Drugs/Medication Chloruretic diuretics
  • Bumetanide
  • Chlorothiazide
  • Metolazone
 + + + ↓ Contraction alkalosis  
Penicillin + ↓
Licorice + + ↓
Laxative abuse +
Antacids 
  • Aluminum hydroxide
  • Sodium polystyrene sulfonate  
 +
Category Disease Hydrogen loss Accumulation of base Chloride depletion Mineralocorticoid excess Fever Dyspnea Edema Toxic/ill BP Dehydration HCO3− paCO2 O2 Cl− K+ Na+ Ca+ Mg+ Renin Bun Cr Urine Cl− Gold standard diagnosis Other findings
Gastrointestinal origin Vomiting + + + ↓ ↓
Nasogastric tube suction + + + ↓ ↓
Zollinger−Ellison syndrome
Bulimia + + ↓
Congenital chloridorrhea + +
Pyloric stenosis +
Villous adenoma + +
Gastrocystoplasty +
Category Disease Hydrogen loss Accumulation of base Chloride depletion Mineralocorticoid excess Fever Dyspnea Edema Toxic/ill BP Dehydration HCO3− paCO2 O2 Cl− K+ Na+ Ca+ Mg+ Renin Bun Cr Urine Cl− Gold standard diagnosis Other findings
Renal origin HTN ↑
Posthypercapnic state + +
Hypomagnesemia − ↓ Nl
Hypokalemia + − ↓ Nl
Bartter's syndrome + + − Nl
Gitelman’s syndrome + +
Renal artery stenosis ↑ ↑ Nl
Liddle syndrome +
Renal tumors
Endocrine Cushing's syndrome ↑ ↓ Nl
Hyperaldosteronism Primary ↑ ↓ ↓ Nl
Secondary ↓
Adrenal enzyme defects 11β−Hydroxylase deficiency ↓ ↓
17α−Hydroxylase deficiency ↓ ↓
Hypercalcemia/hypoparathyroidism +
Systemic Cystic fibrosis  +
Category Disease Hydrogen loss Accumulation of base Chloride depletion Mineralocorticoid excess Fever Dyspnea Edema Toxic/ill BP Dehydration HCO3− paCO2 O2 Cl− K+ Na+ Ca+ Mg+ Renin Bun Cr Urine Cl− Gold standard diagnosis Other findings
  1. ↑ Galla JH (February 2000). "Metabolic alkalosis". J. Am. Soc. Nephrol. 11 (2): 369–75. PMID 10665945.
  2. ↑ Máttar, João A.; Weil, Max Harry; Shubin, Herbert; Stein, Leon (1974). "Cardiac arrest in the critically III". The American Journal of Medicine. 56 (2): 162–168. doi:10.1016/0002-9343(74)90593-2. ISSN 0002-9343.
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