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Acid Base Disorders - Alkalosis
Allan B. Schwartz, MD, is professor of medicine, Division of Nephrology and Hypertension, Drexel University College of Medicine. Here, he defines metabolic alkalosis as an alkaline blood pH together with an increased plasma bicarbonate concentration and illustrates the usual pattern of electrolyte abnormalities seen in metabolic alkalosis. Dr. Schwartz shows how to confirm the presence of metabolic alkalosis, and provides "four easy steps" for diagnosis. The etiology of metabolic alkalosis is primarily divided into chloride-dependent or chloride-resistant metabolic acidosis. All metabolic alkalosis, he says, is hypochloremic, and he describes a metabolic maneuver by Drs. Jerome Kassirer and William Schwartz for selective depletion of hydrochloric acid. Combined chloride-deficient and volume-contraction states with high renin-angiotensin-aldosterone activity can result in metabolic alkalosis, says the author, and the role of volume homeostasis is "explicitly important." Sodium avidity is also important in the process of volume contraction. The lecture features a diagram showing electrolyte patterns in metabolic alkalosis, and touches upon Bartter's syndrome and Gitelman's syndrome as examples of chloride-resistant metabolic alkalosis. The lecture concludes with a discussion of Cushing's syndrome, which is associated withy adrenal hyperplasia; and Liddle's syndrome, a rare genetic autosomal dominant disorder which resembles primary hyperaldosteronism. |
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