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__NOTOC__
== Metabolic Alkalosis ==
'''For the WikiDoc page for this topic, click [[Dermatomyositis|here]]'''
'''''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"
{{Dermatomyositis (patient information)}}
! rowspan="4" |Category
 
! colspan="2" rowspan="4" |Disease
{{CMG}}; '''Associate Editor-In-Chief''': Jinhui Wu, MD,  [[User:Ujjwal Rastogi|Ujjwal Rastogi, MBBS]] [mailto:urastogi@perfuse.org]
! colspan="4" rowspan="3" |Mechanism
 
! colspan="6" |Clinical
==Overview==
! colspan="12" |Paraclinical
Dermatomyositis is an uncommon inflammatory myopathy accompanied with a skin [[rash]]. The cause is unknown and researches suggest that it is associated with autoimmune disorders. Common signs and symptoms of dermatomyositis include [[difficulty swallowing]], [[muscle weakness]], purple-red skin [[rash]], [[shortness of breath]], [[fatigue]] and [[weight loss]]. Electromyography, even [[muscle biopsy]] or [[skin biopsy]] may help diagnose dermatomyositis. There is no cure for dermatomyositis. [[Medication]]s and [[physical therapy]] may help relieve symptoms and maintain muscle strength. Prognosis of dermatomyositis varies from person to person. It depends on whether the patient appear severe [[complication]]s.
! rowspan="4" |Gold standard diagnosis
 
! rowspan="4" |Other findings
==What are the symptoms of Dermatomyositis?==
|-
[[Image:heliotrope_rash_(Dermatomyositis).jpg|thumb|200px|left|Heliotrope rash (Dermatomyositis) Prox muscle weakness]]
! colspan="3" rowspan="2" |Symptoms
The most common signs and symptoms of dermatomyositis include:
! colspan="3" rowspan="2" |Signs
:*[[Difficulty swallowing]]
! colspan="12" |Lab data
:*[[Muscle weakness]], [[stiffness]], or [[soreness]], appearing suddenly or developing slowly over weeks or months.
|-
:*Purple or violet colored upper eyelids
! colspan="3" |ABG
:*Purple-red skin [[rash]] over the face, knuckles, neck, shoulders, upper chest, and back.
! colspan="5" |Chemistry
:*[[Shortness of breath]]
!
:*[[Fatigue]] and [[weight loss]]
! colspan="3" |Renal function
:*[[Fever]]
|-
:*Gastrointestinal [[ulcer]]s and [[intestinal perforation]]s in children
!Hydrogen loss
 
!Accumulation of base
 
!Chloride depletion
Diseases that can present with similar symptoms are
!Mineralocorticoid excess
:*[[Hypothyroidism]]
!Fever
:*[[Sarcoidosis]]
!Dyspnea
 
!Edema
==What causes Dermatomyositis?==
!Toxic/ill
Its an autoimmune disease who's actual cause is unknown.
!BP
 
!Dehydration
==Who is at highest risk?==  
!HCO<sub>3</sub><sup>−</sup>
The cause of dermatomyositis is unknown. Its more commonly found in women in extremes of age-group. Also presence of one connective tissue disorder or any other [[cancer]] makes you prone for it.
!paCO<sub>2</sub>
 
!O<sub>2</sub>
==Diagnosis==
!Cl<sup>−</sup>
:*[[Medical history]] and [[physical examination]]
!K<sup>+</sup>
:*Blood test: Blood tests such as [[creatine kinase]] (CK) and [[aldolase]] may help diagnose dematomyositis. Patients with dematomyositis may show increased CK and aldolase levels, indicating muscle damage.
!Na<sup>+</sup>
:*[[Electromyography]]: During this procedure, the doctor inserts a thin needle electrode into the muscle and measure electrical activities when the patient relaxs or tightens the muscle.The doctor can identify a muscle disease by analysing these electrical activities.
!Ca<sup>+</sup>
:*[[Muscle biopsy]]: During this procedure, the doctor removes a small piece of muscle tissue surgically and detects in the pathological lab. Under microscope, tissues of patients with dermatomyositis may demonstrate that inflammatory cells surround and damage the capillary blood vessels in the muscle.
!Mg<sup>+</sup>
:*Muscle [[MRI]]: This image can detect subtle muscle inflammation and swelling early in the disease.
!Renin
:*[[Skin biopsy]]: The goal of skin biopsy is to identify the diagnosis of dermatomyositis and rule out other disease such as [[systemic lupus erythematosus]]. During this procedure, the doctor removes a small piece of skin tissue surgically and detects in the pathological lab.
!Bun
 
!Cr
==When to seek urgent medical care?==
!Urine Cl<sup>−</sup>
Call your health care provider if symptoms of dermatomyositis develop.
|-
 
| rowspan="3" |Exogenous HCO<sub><big>3</big></sub><sup>−</sup> loads
==Treatment options==
| 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>
There is no cure for dermatomyositis. The goal of treatment is to relieve symptoms. 
|−
*General treatment
| +
:*Keep a regular exercise to maintain your muscle strength.
|−
:*Bedrest when you feel tied.
|−
:*Avoid exposure to sunshine: Use suncream and protective clothing may prevent your [[rash]] worse.
| -
*[[Medication]]s
|<nowiki>+</nowiki>
:*[[Corticosteroid]]s: Corticosteroids can decrease swelling and inflammation by suppressing the immune system. [[Side effect]]s of corticosteroids may include a decreased ability against [[infection]], worse healing in the wound and [[osteoporosis]].
|<nowiki>-</nowiki>
:*[[Immunosuppressant]]s: Immunosuppressive drugs, such as [[cyclophosphamide]], [[mycophenolate mofetil]], or [[azathioprine]], may be used if the patient has an inadequate response or excessive sensitivity to corticosteroids.
|<nowiki>+</nowiki>
:*[[Cytotoxic drug]]s: These kind of drugs may interfere with growth of normal and neoplastic cells by cross-linking of [[DNA]] or [[RNA]] or [[protein]]s and can improve signs and symptoms of dermatomyositis. Usual drugs include [[cyclophosphamide]] and [[azathioprine]]. [[Side effect]]s include marrow suppression, liver damage, [[nausea]] and [[vomiting]].
|↓
:*[[Intravenous immunoglobulin]] (IVIg): High dose of [[immunoglobulin]] can inhibit the damaging antibodies to attack muscle and skin in dermatomyositis.
|↓
:*Antimalarial medications: These type of drugs, such as [[hydroxychloroquine]] and [[chloroquine]], can be used to trear a persistent [[rash]].
|↑
*[[Physical therapy]]: The physical therapist can make an exercise plan to help you maintain and improve muscle strength and flexibility.
|↑
*[[Surgery]]: Surgery may be used to remove local areas of [[calcinosis]].
|↓
 
|↓
==Where to find medical care for Dermatomyositis?==
|↓
[http://maps.google.com/maps?f=q&amp;hl=en&amp;geocode=&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|dermatomyositis}}}}&amp;sll=37.0625,-95.677068&amp;sspn=65.008093,112.148438&amp;ie=UTF8&amp;ll=37.0625,-95.677068&amp;spn=91.690419,149.414063&amp;z=2&amp;source=embed Directions to Hospitals Treating dermatomyositis]
|↓
 
|↑
==Prevention==
|Nl
 
|
==What to expect (Outlook/Prognosis)?==
|
Prognosis of dermatomyositis varies from person to person. Some children with dermatomyositis may recover, while other adults may die of [[complication]]s. It depends on:
|
:*Therapy respond of the patient.
|
:*Whether the patient appear [[complication]]s, such as [[acute renal failure]], [[cancer]], inflammation of the heart, [[joint pain]] or lung disease.
|
 
|
==Possible complications==
* Post treatment of [[lactic acidosis]] or [[ketoacidosis]]  
It can have various complication depending upon the system involvement
|-
*Muscular Involvement present as difficulty swallowing, aspiration pneumonia,
| colspan="2" |Milk−alkali syndrome
*Skin Involvement present as infections and [[calcinosis]] 
| -
 
| +
==Sources==
| -
http://www.nlm.nih.gov/medlineplus/ency/article/000839.htm
| +
 
| -
[[Category:Patient information]]
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[[Category:Dermatology patient information]]
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[[Category:Dermatology]]
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[[Category:Rheumatology]]
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[[Category:Rheumatology patient information]]
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[[Category:Overview complete]]
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[[Category:For review]]
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{{WH}}
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{{WS}}
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| colspan="2" |Transfusion
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| rowspan="5" |Drugs/Medication
|Chloruretic diuretics
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* Bumetanide
* Chlorothiazide
* Metolazone
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|Contraction alkalosis  
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|Penicillin
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|Licorice
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|Laxative abuse
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|Antacids 
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* Aluminum hydroxide
* Sodium polystyrene sulfonate  
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!Category
! colspan="2" |Disease
!Hydrogen loss
!Accumulation of base
!Chloride depletion
!Mineralocorticoid excess
!Fever
!Dyspnea
!Edema
!Toxic/ill
!BP
!Dehydration
!HCO<sub>3</sub><sup>−</sup>
!paCO<sub>2</sub>
!O<sub>2</sub>
!Cl<sup>−</sup>
!K<sup>+</sup>
!Na<sup>+</sup>
!Ca<sup>+</sup>
!Mg<sup>+</sup>
!Renin
!Bun
!Cr
!Urine Cl<sup>−</sup>
!Gold standard diagnosis
!Other findings
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| rowspan="8" |Gastrointestinal origin
|Vomiting
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|Nasogastric tube suction
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|Zollinger−Ellison syndrome
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|Bulimia
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|Congenital chloridorrhea
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|Pyloric stenosis
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|Villous adenoma
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!Category
! colspan="2" |Disease
!Hydrogen loss
!Accumulation of base
!Chloride depletion
!Mineralocorticoid excess
!Fever
!Dyspnea
!Edema
!Toxic/ill
!BP
!Dehydration
!HCO<sub>3</sub><sup>−</sup>
!paCO<sub>2</sub>
!O<sub>2</sub>
!Cl<sup>−</sup>
!K<sup>+</sup>
!Na<sup>+</sup>
!Ca<sup>+</sup>
!Mg<sup>+</sup>
!Renin
!Bun
!Cr
!Urine Cl<sup>−</sup>
!Gold standard diagnosis
!Other findings
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| rowspan="9" |Renal origin
|HTN
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|Posthypercapnic state
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|Hypomagnesemia
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|Hypokalemia
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|Bartter's syndrome
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|Gitelman’s syndrome
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|Nl
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|Liddle syndrome
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|Renal tumors
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| rowspan="6" |Endocrine
|Cushing's syndrome
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| rowspan="2" |Hyperaldosteronism
|Primary
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|Secondary
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| rowspan="2" |Adrenal enzyme defects
|11β−Hydroxylase deficiency
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|17α−Hydroxylase deficiency
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|Hypercalcemia/hypoparathyroidism
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|Systemic
|Cystic fibrosis 
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!Category
! colspan="2" |Disease
!Hydrogen loss
!Accumulation of base
!Chloride depletion
!Mineralocorticoid excess
!Fever
!Dyspnea
!Edema
!Toxic/ill
!BP
!Dehydration
!HCO<sub>3</sub><sup>−</sup>
!paCO<sub>2</sub>
!O<sub>2</sub>
!Cl<sup>−</sup>
!K<sup>+</sup>
!Na<sup>+</sup>
!Ca<sup>+</sup>
!Mg<sup>+</sup>
!Renin
!Bun
!Cr
!Urine Cl<sup>−</sup>
!Gold standard diagnosis
!Other findings
|}

Revision as of 14:55, 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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