Saturday, June 15, 2024

Pediatric Metabolic Alkalosis

Background

Metabolic alkalosis is an acid-base disturbance caused by an elevation in the plasma bicarbonate (HCO3) concentration. This condition is not a disease; it is a sign or state encountered in certain disease processes. Although metabolic alkalosis may not be referred to as often as metabolic acidosis, it is the most common acid-base abnormality in hospitalized adults,
particularly those in the intensive care unit (ICU).
Alkalosis refers to a loss of acid or gain of base in the extracellular fluid (ECF); alkalemia refers to a change in blood pH. Alkalosis is not necessarily accompanied by alkalemia.

The two types of metabolic alkalosis (ie, chloride-responsive, chloride-resistant) are classified based on the amount of chloride in the urine.

Chloride-responsive metabolic alkalosis involves urine chloride levels of less than 20 mEq/L, is typically found to be below 10 mEq/L, and is characterized by decreased ECF volume and low serum chloride levels, such as occurs with vomiting. This type responds to administration of chloride salt.

Chloride-resistant metabolic alkalosis involves urine chloride levels above 20 mEq/L and is characterized by increased ECF volume. As the name implies, this type resists administration of chloride salt. Primary aldosteronism is an example of chloride-resistant metabolic alkalosis.

For a review of metabolic alkalosis in patients of all ages, see Metabolic Alkalosis.

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