Sandbox: wdx causes

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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 Enzyme 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 Nl ↑ ↑ Nl Clinical
Milk−alkali syndrome[3] − + − + − + − + ↓ + ↑ ↑ ↓ ↓ ↓ ↓ ↑ ↓ ↑ ↑ ↑ Nl Clinical + exclusion of other causes of hypercalcemia
Transfusion[4] − + − − ± ± − + ↓ − ↑ ↑ ↓ ↓ ↓ ↑ ↓ ↓ ↑ ↑ Nl to ↑ Nl to ↑ Nl History of administration of large quantities of blood products that contain sodium citrate
Drugs/Medication Chloruretic diuretics[5]
  • Bumetanide
  • Chlorothiazide
  • Metolazone
 + − + + − − − − ↓ + ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl to ↑ Nl to ↑ ↑ History
Penicillin[6] + − − − − − − − Nl − ↑ ↑ Nl ↓ ↓ ↑ Nl ↓ ↑ Nl Nl Nl History
Licorice[7][8] + − − + − − − + Nl to ↑ − ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl to ↑ Nl to ↑ Nl Clinical
Laxative abuse[9] + − + − - − ± + ↓ + ↑ ↑ Nl ↓ ↓ ↑ Nl ↑ ↑ Nl to ↑ Nl ↓ High level of suspicion
Antacids[10][11]
  • Aluminum hydroxide
  • Sodium polystyrene sulfonate  
 + + − − − − − − Nl − ↑ ↑ Nl ↓ ↓ ↑ Nl ↑ Nl Nl to ↑ Nl to ↑ Nl Clinical
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[12] + − + − ± − − + ↓ + ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl to ↑ Nl ↓ Clinical
Nasogastric tube suction[13] + − + − − − − + ↓ + ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl to ↑ Nl ↓ Clinical
Zollinger−Ellison syndrome[14] + − + − - − − + ↓ + ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl to ↑ Nl ↓ Serum gastrin concentration + secretin stimulation test 
Bulimia nervosa[15] + − + − - − ± + ↓ + ↑ ↑ Nl ↓ ↓ ↓ Nl ↓ ↑ Nl to ↑ Nl ↓ High level of suspicion
Congenital chloridorrhea[16] + - + - - - ± + ↓ + ↑ ↑ Nl ↓ ↓ ↓ ↓ ↓ ↑ Nl to ↑ Nl to ↑ Nl to ↑
Pyloric stenosis + − + − - − − + ↓ + ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl to ↑ Nl ↓ Clinical
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 - - + + - ± - - Nl − ↑ ↑↑ ↓ ↓ ↓ ↑ Nl Nl ↑ Nl Nl Nl Lab data Chronic respiratory acidosis  
Hypomagnesemia + − − − − − − − Nl − ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl Nl Nl Lab data
Hypokalemia + − − − − − − − Nl − ↑ ↑ Nl ↓ ↓ ↑ Nl Nl ↑ Nl Nl Nl Lab data
Bartter's syndrome + + Nl ↑ 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.
  3. ↑ Abreo, Kenneth (1993). "The Milk-Alkali Syndrome". Archives of Internal Medicine. 153 (8): 1005. doi:10.1001/archinte.1993.00410080065011. ISSN 0003-9926.
  4. ↑ Gupta M, Wadhwa NK, Bukovsky R (January 2004). "Regional citrate anticoagulation for continuous venovenous hemodiafiltration using calcium-containing dialysate". Am. J. Kidney Dis. 43 (1): 67–73. PMID 14712429.
  5. ↑ Luke, R. G.; Galla, J. H. (2012). "It Is Chloride Depletion Alkalosis, Not Contraction Alkalosis". Journal of the American Society of Nephrology. 23 (2): 204–207. doi:10.1681/ASN.2011070720. ISSN 1046-6673.
  6. ↑ Zaki, SyedAhmed; Lad, Vijay (2011). "Piperacillin-tazobactam-induced hypokalemia and metabolic alkalosis". Indian Journal of Pharmacology. 43 (5): 609. doi:10.4103/0253-7613.84986. ISSN 0253-7613.
  7. ↑ Meltem, Akkas Camkurt; Figen, Coskun; Nalan, Metin Aksu; Mahir, Kunt; Sebnem, Bozkurt; Mehlika, Isildak; Kasim, Kilic Ahmet; Miyase, Bayraktar (2009). "A hypokalemic muscular weakness after licorice ingestion: a case report". Cases Journal. 2 (1): 8053. doi:10.4076/1757-1626-2-8053. ISSN 1757-1626.
  8. ↑ Lin, Shih-Hua; Yang, Sung-Sen; Chau, Tom; Halperin, Mitchell L. (2003). "An Unusual Cause of Hypokalemic Paralysis: Chronic Licorice Ingestion". The American Journal of the Medical Sciences. 325 (3): 153–156. doi:10.1097/00000441-200303000-00008. ISSN 0002-9629.
  9. ↑ Roerig, James L.; Steffen, Kristine J.; Mitchell, James E.; Zunker, Christie (2010). "Laxative Abuse". Drugs. 70 (12): 1487–1503. doi:10.2165/11898640-000000000-00000. ISSN 0012-6667.
  10. ↑ Sahani, Mandeep M.; Brennan, John F.; Nwakanma, Chukwuemeka; Chow, May T.; Ing, Todd S.; Leehey, David J. (2001). "Metabolic Alkalosis in a Hemodialysis Patient After Ingestion of a Large Amount of an Antacid Medication". Artificial Organs. 25 (4): 313–315. doi:10.1046/j.1525-1594.2001.06714.x. ISSN 0160-564X.
  11. ↑ Vanpee, Dominique; Delgrange, Etienne; Gillet, Jean-Bernard; Donckier, Julian (2000). "Ingestion of antacid tablets (Rennie®) and acute confusion". The Journal of Emergency Medicine. 19 (2): 169–171. doi:10.1016/S0736-4679(00)00206-7. ISSN 0736-4679.
  12. ↑ Gan, Tong J.; Meyer, Tricia; Apfel, Christian C.; Chung, Frances; Davis, Peter J.; Eubanks, Steve; Kovac, Anthony; Philip, Beverly K.; Sessler, Daniel I.; Temo, James; Tram??r, Martin R.; Watcha, Mehernoor (2003). "Consensus Guidelines for Managing Postoperative Nausea and Vomiting". Anesthesia & Analgesia: 62–71. doi:10.1213/01.ANE.0000068580.00245.95. ISSN 0003-2999.
  13. ↑ Gilbertson, Heather Ruth; Rogers, Elizabeth Jessie; Ukoumunne, Obioha Chukwunyere (2011). "Determination of a Practical pH Cutoff Level for Reliable Confirmation of Nasogastric Tube Placement". Journal of Parenteral and Enteral Nutrition. 35 (4): 540–544. doi:10.1177/0148607110383285. ISSN 0148-6071.
  14. ↑ Hung, Patrick D.; Schubert, Mitchell L.; Mihas, Anastasios A. (2003). "Zollinger-Ellison syndrome". Current Treatment Options in Gastroenterology. 6 (2): 163–170. doi:10.1007/s11938-003-0017-6. ISSN 1092-8472.
  15. ↑ Shapiro, Jennifer R.; Berkman, Nancy D.; Brownley, Kimberly A.; Sedway, Jan A.; Lohr, Kathleen N.; Bulik, Cynthia M. (2007). "Bulimia nervosa treatment: A systematic review of randomized controlled trials". International Journal of Eating Disorders. 40 (4): 321–336. doi:10.1002/eat.20372. ISSN 0276-3478.
  16. ↑ Wedenoja, S.; Hã–Glund, P.; Holmberg, C. (2010). "Review article: the clinical management of congenital chloride diarrhoea". Alimentary Pharmacology & Therapeutics. 31 (4): 477–485. doi:10.1111/j.1365-2036.2009.04197.x. ISSN 0269-2813. C1 control character in |last2= at position 3 (help)
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