Metabolic alkalosis

Under a metabolic alkalosis (also non-respiratory alkalosis ) is defined as a by metabolism ( metabolic ) related increase in blood pH above 7.43 ( alkalosis).

Causes

In general, be distinguished Subtraktionsalkalosen of addition.

Additionsalkalosen are the consequence of treatment with basic acting drugs, such as sodium bicarbonate or citrate.

Subtraktionsalkalosen are often triggered by the treatment with loop diuretics. If vomiting or gastric drainage ( secrete of gastric contents ) can also occur due to loss of (hydrogen and chloride ions ) to a gastric Subtraktionsalkalose.

Physiological compensatory mechanisms

The rule of thumb that metabolically related derailments of the acid- base balance are compensated respiratory and vice versa, is problematic in the case of metabolic alkalosis. To compensate hypoventilation would be necessary to increase the carbon dioxide partial pressure in the alveolar air and in the blood and so to shift the equilibrium of the Bikarbonatpuffers (CO2 H2O ↔ H2CO3 ↔ H HCO3- ) to the right. This would lead to a " acidification " of the blood pH and thus compensate for the alkalosis.

Due to the oxygen demand of the organism hypoventilation is only a very limited extent possible, so that a metabolic alkalosis by excretion of bicarbonate (base) renal is compensated.

Symptoms

In addition to the above hypoventilation as a compensatory mechanism often occur as a result of ventricular arrhythmias associated hypokalemia. The prevailing FCA deficit (due to take place in the kidney exchange of Na - and K - H ions as additional compensation mechanism, with Na H2O pulls with it ) manifests itself in hypotension and weakness. Neurologically pass through these electrolyte shifts paraesthesia, convulsions, to tetany, confusion and stupor on ( as a deep Na concentration in the FCA -lasting depolarization causes but which are not reversed through the deep K levels via the Na -K -ATPase, but remain locked ).

Therapy

Therapeutically is the correction of the usually strong electrolyte imbalance in the foreground. Case of severe alkalosis arginine hydrochloride is used intravenously. A central catheter and small quantities of hydrochloric acid can be given.

(Infusion therapy)