Metabolic alkalosis

The manifestations of this condition are linked to the patient's history such as in cases with vomiting or diarrhea. Also, electrolyte deficiencies are associated with specific clinical features. For example, hypokalemia results in weakness, polyuria, myalgia, and serious sequelae such as cardiac arrhythmias while hypocalcemia produces remarkable findings that include altered mental status, tetany, Trousseau sign, Chvostek sign, and possibly seizures. Additionally, volume changes are characterized by signs of dehydration such as orthostatic hypotension, dry mucous membranes, decreased urine output, etc.

Respiratory alkalosis

The symptoms reflect the etiology, duration of the alkalosis, and its degree. Hyperventilation leads to acute hypocapnia, which in turn decreases cerebral perfusion. Therefore, patients experience confusion, lightheadedness, loss of consciousness, and seizures. Also, patients with hyperventilation syndrome develop dyspnea, chest pain, paresthesia, and tetany [7].

Common features on the exam include tachypnea, tachycardia, and arrhythmias. Signs of hypocalcemia may also develop [8].

Patients with chronic respiratory alkalosis do not usually exhibit symptoms.

• Pain

  If pain is causing the person to breathe rapidly, relieving the pain usually suffices. When respiratory alkalosis is caused by anxiety or a panic attack, a conscious effort to relax and slow breathing may make the condition disappear. [merckmanuals.com]

  […] disease, history of asthma, history of COPD, acute focal neurological signs, numbness, paresthesia, abdominal pain, nausea, vomiting, tinnitus, or weight loss. [ncbi.nlm.nih.gov]

  Symptoms of respiratory alkalosis may include: anxiety chest pain lightheadedness muscle stiffness numbness around the mouth tremors Respiratory alkalosis may resemble the symptoms pneumonia, acute respiratory distress syndrome, and sepsis, among others [medicalnewstoday.com]

  If your rapid breathing is caused by pain, then treating the pain will help bring your respiratory rate back to normal and improve your symptoms. [healthline.com]

• Fever

  This can be due to: Fever Being at a high altitude Lack of oxygen Liver disease Lung disease, which causes you to breathe faster ( hyperventilate ) Aspirin poisoning Metabolic alkalosis is caused by too much bicarbonate in the blood. [nlm.nih.gov]

  Home | CCC | Respiratory Alkalosis DDx by, last update April 21, 2019 Causes Stimulated respiratory drive CNS CVA, ICH, psychogenic Hypermetabolic Thyrotoxicosis Pregnancy (Progesterone)(Secondary to reduced FRC) Sepsis (fever) (often before metabolic [lifeinthefastlane.com]

  Respiratory Alkalosis is caused by low carbon dioxide levels in the blood; this can be due to a Fever, being at a High Altitude; a Lack of Oxygen; a Liver disease; a Lung disease, which causes you to breathe faster and hyperventilate and Salicylate poisoning [halinaking.co.uk]

  This can be due to: Fever Being at a high altitude Lack of oxygen Liver disease Lung disease, which causes you to breathe faster (hyperventilate) Aspirin poisoning Metabolic alkalosis is caused by too much bicarbonate in the blood. [ufhealth.org]

  Other causes of hyperventilation and consequent respiratory alkalosis include pain, low levels of oxygen in the blood, fever, and aspirin overdose (which can also cause metabolic acidosis). [merckmanuals.com]

• Vomiting

  DISCUSSION This is the first case report in the literature of vomiting induced metabolic alkalosis causing myoclonus. [pmj.bmj.com]

  The most common causes of metabolic alkalosis are vomiting, nasogastric suction, and diuretic therapy. [ime.acponline.org]

  Vomiting in other conditions may involve a mixture of acid gastric loss and alkaline duodenal contents and the acid-base situation that results is more variable. [ld99.com]

  In the past 4 months he had experienced intermittent generalized abdominal pain, nausea, anorexia, vomiting, and mild weight loss (3 kg). He had presented 2 months earlier with vomiting. [aacc.org]

  IV NaHCO3 infusion, citrate in transfused blood) from an endogenous source (e.g. metabolism of ketoanions to produce bicarbonate) LOSS OF H+ FROM ECF via kidneys (e.g. use of diuretics) via gut (e.g. vomiting, NG suction) Maintenance of Alkalosis maintenance [litfl.com]

• Diarrhea

  Diarrhea, when watery (see the image below), is highly suggestive of chloride-losing diarrhea. Watery stool from an infant with congenital chloride-losing diarrhea. Chloride level was 205 mmol/L. [emedicine.medscape.com]

  Salines can also be issued if there is too much diarrhea, and they increase the acidity levels, and help maintain a health pH level for the blood. This entry was posted in Uncategorized. Bookmark the permalink. [fmss12ucheme.wordpress.com]

  "Congenital Chloride Diarrhea: Accurate Prenatal Diagnosis Using Color Doppler Sonography to Show the Passage of Diarrhea". Journal of Ultrasound in Medicine. 34 (11): 2113–2115. doi : 10.7863/ultra.15.01011. ISSN 0278-4297. ^ a b Bates, C. [en.wikipedia.org]

  Diarrhea usually causes metabolic acidosis because of the bicarbonate loss; however, congenital or acquired enteropathy with chloridorrhea may result in bicarbonate excess and metabolic alkalosis. [edoc.mdc-berlin.de]

  Metabolic alkalosis can occur secondary to diuretic use, loss of gastric acid (due to emesis, diarrhea, or nasogastric suction), excessive antacid intake, and other causes. [symptoma.com]

• Tachycardia

  Physical exam findings may be just as varied depending on etiology to include fever, tachycardia, tachypnea, diaphoresis, hyper or hypotension, altered mental status, productive or non-productive cough, wheezing, rales, crackles, cardiac murmur or arrhythmia [ncbi.nlm.nih.gov]

  Common features on the exam include tachypnea, tachycardia, and arrhythmias. Signs of hypocalcemia may also develop. Patients with chronic respiratory alkalosis do not usually exhibit symptoms. [symptoma.com]

  This can lead to ventricular tachycardia and sudden death. [ 11, 12 ] Management Electrolyte replacement - eg, potassium, magnesium and sometimes sodium. [patient.info]

  Ventricular tachycardia associated with hereditary magnesium-losing nephropathy. Int J Cardiol 2006 ; 113 : e42 – 3 6. Aborted sudden cardiac death in two patients with Bartter's/Gitelman's syndromes. Clin Nephrol 2007 ; 67 : 193 – 7 7. [academic.oup.com]

• Palpitations

  Symptoms of intravascular volume depletion, such as lightheadedness, dizziness, decreased oral intake, syncope or palpitations should be elicited. Diuretic use should be queried as part of the medication history. [oncologynurseadvisor.com]

• Ulcer

  It was realized that even n /10 acid would soon cause ulceration, but the difficulty of administering fluids orally to mice left no other course open. Ulceration was avoided as much as possible by varying the injection site. Received August 3, 1922. [cancerres.aacrjournals.org]

  In adults it may be due to scarring from previous benign ulceration related to peptic ulcer disease, or to encroachment of the pyloric canal by a tumor, most commonly distal gastric cancer. [surgstudent.org]

  Excessive ingestion of bicarbonate may occur in patients attempting to treat their peptic ulcer disease with Sodium Bicarbonate. Major bouts of vomiting can lead to direct loss of stomach acid. [pathwaymedicine.org]

  This revealed resolving duodenal ulcers and also the presence of a vitamin bottle cap that the patient recalled accidentally swallowing. [acutecaretesting.org]

  He has had problems with peptic ulcer disease in the past and has been having similar pain for the past two weeks. [courses.washington.edu]

• Formication

  […] gap Etiology Further evaluation: measure urine anion gap = [Urine Na+] + [urine K+] - [urine Cl-] High anion gap metabolic acidosis Increased concentration of organic acids such as lactate, ketoacids (beta-hydroxybutyrate, acetoacetate), oxalic acid, formic [amboss.com]

• Muscle Spasm

  Metabolic Alkalosis is usually accompanied with Hypokalemia, causing muscular weakness, Myalgia and Muscle Cramps, owing to disturbed function of the Skeletal Muscles, and Muscle Spasms, from the disturbed function of smooth muscles; it may also cause [halinaking.co.uk]

  Muscle twitching. Nausea, vomiting. Numbness or tingling in the face, hands, or feet. Prolonged muscle spasms (tetany) [studykorner.com]

  People may have irritability, muscle twitching, muscle cramps, or even muscle spasms. Blood is tested to diagnose alkalosis. [merckmanuals.com]

• Muscle Cramp

  People may have irritability, muscle twitching, muscle cramps, or even muscle spasms. Blood is tested to diagnose alkalosis. [merckmanuals.com]

  […] pain, and muscle cramps (from disturbed function of the skeletal muscles), and muscle spasms (from disturbed function of smooth muscles). [en.wikipedia.org]

  Muscle cramps and a lot of production of lactic acid from working out, can also increase in acidity. Anything that increases the number of carbon dioxide or carbonic acid in the blood leads to acidosis. [fmss12ucheme.wordpress.com]

• Muscle Twitch

  Muscle twitching. Nausea, vomiting. Numbness or tingling in the face, hands, or feet. Prolonged muscle spasms (tetany) [studykorner.com]

  People may have irritability, muscle twitching, muscle cramps, or even muscle spasms. Blood is tested to diagnose alkalosis. [merckmanuals.com]

  twitching, and myoclonus and may be partly due to decreased serum ionised calcium concentrations.3 Chvostek’s sign is usually negative.4 Symptoms of muscle twitching and tetany appear to be more common than myoclonus. [pmj.bmj.com]

• Carpopedal Spasm

  He was described as having “locked hands and curled toes” consistent with carpopedal spasms and twitching movements of his tongue. He had no focal neurological signs, and his power and reflexes were essentially normal. [aacc.org]

  spasm Shift 02 dissociation curve to the left (Alkalosis) (Increased affinity of Hb for O2) Correction Treat underlying cause Re-breather mask References and Links Acid-Base: ABG analysis – Anion Gap – SID – NAGMA Metabolic acidosis: Overview – evaluation [lifeinthefastlane.com]

  spasm Type 1 Excludes hysterical tetany ( F44.5 ) neonatal tetany ( P71.3 ) parathyroid tetany ( E20.9 ) post-thyroidectomy tetany ( E89.2 ) alkalosis E87.3 ICD-10-CM Codes Adjacent To E87.3 E85.9 Amyloidosis, unspecified E86 Volume depletion E86.9 Volume [icd10data.com]

  Paresthesias, carpopedal spasm. Hypoventilation (due to respiratory compensation for the metabolic alkalosis). Generally not a significant issue. [emcrit.org]

  These associated electrolyte abnormalities can also cause carpopedal spasms, muscle weakness, and altered mental status. Consultations Depending upon the primary etiology of the alkalosis, consultation may be necessary with various subspecialties. [ncbi.nlm.nih.gov]

• Confusion

  Call your provider if you become confused, unable to concentrate, or unable to "catch your breath." [nlm.nih.gov]

  Symptoms Symptoms of alkalosis can include any of the following: Confusion (can progress to stupor or coma) Hand tremor Lightheadedness Muscle twitching Nausea, vomiting Numbness or tingling in the face, hands, or feet Prolonged muscle spasms (tetany) [ufhealth.org]

  Signs & Symptoms of Metabolic and Respiratory Alkalosis Symptoms of alkalosis can include any of the following: Confusion (can progress to stupor or coma) Hand tremor. Lightheadedness. Muscle twitching. Nausea, vomiting. [studykorner.com]

  You are dizzy, confused, or lose consciousness. You have a seizure. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

• Seizure

  Shock It is important to recognize that in the case of seizures and shock, it is actually the accumulation of lactic acid that is responsible for the development of the elevated anion gap acidosis. [pulmonaryschools.com]

  Therefore, patients experience confusion, lightheadedness, loss of consciousness, and seizures. Also, patients with hyperventilation syndrome develop dyspnea, chest pain, paresthesia, and tetany. [symptoma.com]

  ‘Serious complications include systemic hypokalemic alkalosis, leading to cardiac arrhythmias, renal damage, and seizures.’ [en.oxforddictionaries.com]

  […] oxyhaemoglobin dissociation curve Cardiovascular consequences: Decreased cardiac output due to decreased contractility Arrhythmias Neurological consequences Neuromuscular overexcitability Decreased cerebral blood flow due to cerebral vasoconstriction Seizures [derangedphysiology.com]

  More severe alkalaemia increases protein binding of ionized Ca + +, leading to hypocalcaemia and subsequent headache, lethargy, and neuromuscular excitability, sometimes with delirium, tetany, and seizures. [pathology.leedsth.nhs.uk]

• Dizziness

  You are dizzy, confused, or lose consciousness. You have a seizure. Care Agreement You have the right to help plan your care. Learn about your health condition and how it may be treated. [drugs.com]

  Symptoms of Diabetic Metabolic Alkalosis Symptoms of diabetic metabolic alkalosis include: light-headedness and dizziness; nausea and vomiting; mental confusion; numbness or tingling in the face and extremities; muscle weakness; myalgia; muscle cramps [battlediabetes.com]

  Symptoms of respiratory alkalosis may include muscle spasms, irritability, dizziness, and nausea. Respiratory alkalosis is one possible classification of an acid-alkaline imbalance in the body. [medicalnewstoday.com]

  Patients may experience: Dizziness Confusion Loss of consciousness Muscle cramps or spasms Abnormal heart rhythms How is it diagnosed? The doctor will ask questions about the patient's health, perform a physical exam, and order blood tests. [symptoma.com]

  Call 911 or go to the nearest emergency room if you experience any of these symptoms: dizziness difficulty breathing confusion stupor coma The symptoms of alkalosis mimic symptoms of other conditions. [healthline.com]

• Tingling

  Numbness or tingling in the face, hands, or feet. Prolonged muscle spasms (tetany) [studykorner.com]

  Alkalosis may cause Irritability Muscle twitching and cramps Tingling in the fingers and toes and around the lips Tingling (paresthesia) is a common complaint in hyperventilation due to anxiety. Sometimes alkalosis causes no symptoms at all. [merckmanuals.com]

  Symptoms of alkalosis can include any of the following: Confusion (can progress to stupor or coma) Hand tremor Lightheadedness Muscle twitching Nausea, vomiting Numbness or tingling in the face, hands, or feet Prolonged muscle spasms (tetany) The health [nlm.nih.gov]

  […] back to normal in cases of Alkalosis, but bicarbonate and carbon dioxide levels remain abnormal; symptoms can include Confusion, which can progress to stupor or coma; Hand tremor; Light headedness; Muscle twitching; Nausea and vomiting; Numbness or Tingling [halinaking.co.uk]

• Irritability

  People may have irritability, muscle twitching, muscle cramps, or even muscle spasms. Blood is tested to diagnose alkalosis. [merckmanuals.com]

Clinical assessment consists of a detailed history including that of medication use, a full physical exam, and the appropriate studies.

Metabolic alkalosis

The key tests include arterial blood gas (ABG) and a complete metabolic panel to evaluate electrolytes, renal function, etc. If the diagnosis is inconclusive, then the urinary chloride concentration should be measured.

Respiratory alkalosis

On ABG, a pH greater than 7.45 indicates alkalemia. If the PaCO2 level is below 35 mm Hg, this reveals a respiratory origin. Also, acute episodes reveal a reduction in bicarbonate levels.

A complete blood cell count (CBC) must be obtained to investigate if sepsis is present. Furthermore, the clinician should obtain cultures of blood, urine, and sputum to rule out infection.

Further tests such as complete metabolic panel and screening for salicylate and theophylline should be performed.

Other diseases associated with hyperventilation should be excluded. Hence, a chest x-ray is crucial to evaluate underlying lung pathologies. Moreover, computerized tomography (CT) studies are obtained if radiography findings are unclear or if lung disease needs to be evaluated further.

• Hyponatremia

  In conclusion, the authors report a rare case of CF with Delta F508/F311L genotype presented with recurrent hyponatremia and metabolic alkalosis. [ncbi.nlm.nih.gov]

  Hyponatremia is a very common electrolyte imbalance in admitted diabetic patients which leads to substantial. Metabolic acidosis, hyponatremia. [edemigid.ml]

  Interactive calculators for anion gap; estimation of fluid requirement in burns (Parkland formula), algorithm explaining diagnostic workup in metabolic alkalosis, hypernatremia and hyponatremia and many more 4. [play.google.com]

  Initial management (≤6 hours) includes the following: Assessment of dehydration status and severity of hypochloremia, hypokalemia, hyponatremia, and metabolic alkalosis In cases of shock, aggressive resuscitation with isotonic fluid, preferably normal [emedicine.medscape.com]

  ICD-10-CM Codes Adjacent To E87.3 E85.9 Amyloidosis, unspecified E86 Volume depletion E86.9 Volume depletion, unspecified E87 Other disorders of fluid, electrolyte and acid-base balance E87.0 Hyperosmolality and hypernatremia E87.1 Hypo-osmolality and hyponatremia [icd10data.com]

Metabolic alkalosis

The management of metabolic alkalosis consists of targeting the underlying etiology and rehydration with intravenous isotonic saline in chloride-responsive patients. Also, electrolyte replacement is paramount.

Additionally, vomiting should be treated with antiemetics and diuretics may be reduced in dose or discontinued if possible. Specific drugs such as potassium-sparing diuretics, carbonic anhydrase inhibitors, hydrochloric acid (HCl), and others may be of benefit [9]. Also, hemodialysis can be performed in cases of severe alkalosis and volume overload in the context of pre-existing kidney disease [10].

Respiratory alkalosis

The main approach to the management of this acid-base disorder aims at the treatment of the underlying condition. Also, patients should be encouraged to try breathing techniques to address the hyperventilation. Furthermore, mechanical ventilation settings may need to be adjusted.

The outcomes of metabolic and respiratory alkalosis are influenced by the causes and the contributing comorbidities.

Specifically, an arterial blood pH equivalent to 7.55 is associated with a 45% mortality rate, which dramatically increases to 80% when the pH is above 7.65 [5] [6].

Metabolic alkalosis can occur secondary to diuretic use, loss of gastric acid (due to emesis, diarrhea, or nasogastric suction) [1], excessive antacid intake, and other causes.

Respiratory alkalosis develops as a consequence of tachypnea and/or hyperventilation, which may emerge secondary to hypoxia, metabolic acidosis, or stressed states such as with fever. This type of alkalosis arises from both pulmonary and extrapulmonary diseases [2].

Acid-base disorders are prevalent in hospitalized patients with metabolic alkalosis being the most predominant. Additionally, respiratory alkalosis is the most common in critically ill individuals [3] and in those with high-risk acute heart failure [4].

Metabolic alkalosis

This increase in serum bicarbonate develops in response to 1) loss of acid, 2) consumption of alkali, 3) intracellular shift of hydrogen ions or 4) contraction alkalosis.

Metabolic alkalosis mainly affects the renal and gastrointestinal systems. Once metabolic alkalosis manifests, hypokalemia, a common feature, maintains the alkalosis through various mechanisms.

Respiratory alkalosis

Alveolar hyperventilation causes PaCO2 to drop below the bicarbonate concentration. In acute episodes or respiratory alkalosis, the pH is basic whereas chronic cases are characterized by a normal or close to normal pH due to metabolic compensation. This condition can affect all organs as it leads to electrolyte and mineral abnormalities.

Clinicians caring for hospitalized patients should be aware of how common these acid-base disorders are and take the proper measures to prevent them or manage them early.

Alkalosis is a condition that is just the opposite of acidosis. It results due to an excess of alkali while acidosis occurs to increased acid level. The imbalance is classified as metabolic and respiratory, which emerges from different causes due to separate processes. The diagnosis is made through assessment of the history, physical exam, and important laboratory tests. Management includes treatment of the underlying disease and the physiological manifestations.

What is alkalosis?

This is a condition in which the blood is alkaline due to the loss of acid or increased amount of bicarbonate. It can also be caused by breathing quickly or deeply. Alkalosis is a very common condition in hospitalized and ill patients.

What are the symptoms?

The symptoms depend on the underlying disease that led to the alkalosis. Patients may experience:

• Dizziness
• Confusion
• Loss of consciousness
• Muscle cramps or spasms
• Abnormal heart rhythms

How is it diagnosed?

The doctor will ask questions about the patient's health, perform a physical exam, and order blood tests.

How is it treated?

The treatment depends on the cause of the alkalosis as underlying diseases should be managed. Also, patients will be treated with fluids, electrolytes, and the appropriate medications.

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3. DuBose TD, Jr. Acidosis and Alkalosis. Kasper DL, Braunwald E, Fauci AS, et al ,eds. Harrison's Principles of Internal Medicine. 16th. New York, NY: McGraw-Hill; 2005. 270-1.
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8. Effros RM, Wesson JA. Acid-Base Balance. Mason RJ, Broaddus VC, Murray JF, Nadel JA, eds. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005. Vol 1: 192-93.
9. Gennari FJ. Pathophysiology of metabolic alkalosis: a new classification based on the centrality of stimulated collecting duct ion transport. American Journal of Kidney Diseases. 2011. 58(4):626-36.
10. Renaud CJ, Ng WP. Conventional bicarbonate haemodialysis in postgastrectomy metabolic alkalosis. Singapore Medical Journal. 2008;49(5):e121–2.