Metabolic alkalosis
DDX
I. Chloride-responsive (urine Cl < 20 mEq/L)
1) Loss of gastric secretions
a) vomiting
b) NG suction
c) bulemia
2) Loss of colonic secretions
a) congenital chloridorrhea
b) villous adenoma
3) Thiazides/loop after D/C
4) Post hypercapnia
5) Cystic fibrosis
II. Chloride-resistant (urine Cl > 20 mEq/L)
1) With HTN
a) Primary hyperaldo
i. adrenal adenoma
ii. bilateral adrenal
iii. hyperplasia
iv. adrenal carcinoma
b) 11B-HSD2
i. genetic, licorice
ii. chewing tobacco
iii. carbenoxolone
c) CAH (11-Hydroxylase or 17-hydroxylase deficiency)
d) Current diuretics + HTN
e) Cushing syndrome
f) Exogenous steroids
g) Liddle syndrome
h) Renovascular HTN
2) Without HTN
a) Bartter syndrome*
b) Gitelman syndrome*
c) Severe K+ depletion
d) Current thiazides/loop
e) Hypomagnesemia
III. Other causes
1) Exogenous alkali (Nabicarb + renal failure, metabolism of lactic acid, or ketoacids)
2) Milk alkali syndrome
3) Hypercalcemia
4) Intravenous penicillin
5) Refeeding alkalosis
6) Massive blood transfusion
- ln children
Source
2/21/06 DONALDSON (adapted from emedicine)