METABOLIC ALKALOSIS-MANAGEMENT

SUMMARY

1. In chloride-responsive alkalosis (when urinary CL < 10), aim treatment at restoration of volume with IV fluids (with either NaCl and/or KCl) and interruption of the cycle, which causes persistent volume loss.

2. Potassium correction is integral to resolving the alkalosis, as well. Both interventions interrupt aldosterone production.

3. The carbonic anhydrase inhibitor, acetazolamide, which increases sodium bicarbonate excretion, can be used in patients who have alkalosis with contraindications to saline or potassium administration (e.g. decompensated heart failure).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].