Metabolic alkalosis

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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)