Metabolic Alkalosis Differential Diagnoses

Updated: Sep 21, 2022
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Diagnostic Considerations

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 intensive care unit (ICU) because arterial blood gases (ABGs) are measured routinely in 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.

For a discussion of metabolic alkalosis in children, see Pediatric Metabolic Alkalosis. For a general review of acid-base regulation, see Metabolic Acidosis.

Differential Diagnoses