eMedicine Specialties > Nephrology > Acid-Base, Fluid, and Electrolyte Disorders

Metabolic Alkalosis: Follow-up

Author: Sameer Yaseen, MD, Staff Nephrologist, Department of Internal Medicine, Division of Nephrology, Mercy Hospital of Des Moines
Coauthor(s): Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics
Contributor Information and Disclosures

Updated: Aug 18, 2009

Follow-up

Complications

  • Alkalosis may lead to tetany, seizures, and decreased mental status. Metabolic alkalosis also decreases coronary blood flow and predisposes persons to refractory arrhythmias.
  • Metabolic alkalosis causes hypoventilation, which may cause hypoxemia, especially in patients with poor respiratory reserve, and it may impair weaning from mechanical ventilation.
  • Metabolic alkalosis is almost always associated with hypokalemia, which can cause neuromuscular weakness and arrhythmias, and, by increasing ammonia production, it can precipitate hepatic encephalopathy in susceptible individuals.

Prognosis

  • Mortality rates have been reported as 45% in patients with an arterial blood pH of 7.55 and 80% when the pH was greater than 7.65.

Miscellaneous

Medicolegal Pitfalls

  • Severe metabolic alkalosis is a life-threatening condition; recognizing and treating the condition appropriately is important. The diagnosis of metabolic alkalosis is difficult to miss in patients in the ICU because ABGs are performed routinely on most of these patients. In non-ICU patients, metabolic alkalosis is suspected if electrolytes show an elevated carbon dioxide level. An elevated carbon dioxide level may also be secondary to respiratory acidosis. Because treatments for the 2 conditions differ, differentiating between them by reviewing the clinical condition of the patient and performing ABGs if the elevation in carbon dioxide is severe is important. In addition, check serum K+ and ionized Ca2+ because metabolic alkalosis is often associated with hypokalemia and decreased serum ionized Ca2+ levels.
 


More on Metabolic Alkalosis

Overview: Metabolic Alkalosis
Differential Diagnoses & Workup: Metabolic Alkalosis
Treatment & Medication: Metabolic Alkalosis
Follow-up: Metabolic Alkalosis
Multimedia: Metabolic Alkalosis
References
Further Reading
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References

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Further Reading

Related eMedicine topics:
Alkalosis, Metabolic
Bartter Syndrome [Nephrology]
Bartter Syndrome [Pediatrics: General Medicine]
Hyperchloremic Acidosis
Hypertrophic Pyloric Stenosis
Hypertrophic Pyloric Stenosis, Surgical Treatment
Metabolic Acidosis [Emergency Medicine]
Metabolic Acidosis [Nephrology]
Respiratory Alkalosis

Clinical guidelines:
Evidence based clinical practice guideline hypertrophic pyloric stenosis. Cincinnati Children's Hospital Medical Center - Hospital/Medical Center.  2001 Aug 8 (revised 2007 Nov 4).  17 pages.  NGC:006224

Clinical trials:
Acetazolamide for Respiratory Failure in Combination With Metabolic Alkalosis
Treatment of Metabolic Alkalosis in Acute Exacerbations of Cystic Fibrosis

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Keywords

metabolic alkalosis, alkalosis, metabolic acidosis, anion gap, respiratory alkalosis, respiratory metabolic alkalosis, bicarbonate, metabolic anion gap, contraction alkalosis, chloride-resistant alkalosis, chloride-responsive alkalosis

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Contributor Information and Disclosures

Author

Sameer Yaseen, MD, Staff Nephrologist, Department of Internal Medicine, Division of Nephrology, Mercy Hospital of Des Moines
Sameer Yaseen, MD is a member of the following medical societies: American Society of Nephrology and Renal Physicians Association
Disclosure: Nothing to disclose.

Coauthor(s)

Christie P Thomas, MBBS, FRCP, FASN, FAHA, Professor, Department of Internal Medicine, Division of Nephrology; Medical Director, Kidney and Kidney/Pancreas Transplant Program, University of Iowa Hospitals and Clinics
Christie P Thomas, MBBS, FRCP, FASN, FAHA is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Nephrology, American Society of Transplantation, American Thoracic Society, International Society of Nephrology, and Royal College of Physicians
Disclosure: Genzyme Grant/research funds Other

Medical Editor

Anil Kumar Mandal, MD, Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida School of Medicine
Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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