Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Related Subjects: |Metabolic acidosis |Metabolic alkalosis |Arterial Blood gas analysis
Cause | Clinical Features | Diagnostic Tests | Management |
---|---|---|---|
Vomiting or Nasogastric Suction |
- Recurrent vomiting or nasogastric suction leads to loss of stomach acid (HCl).
- Symptoms of dehydration (dry mucous membranes, hypotension). |
- Arterial blood gas (ABG): Elevated pH, elevated bicarbonate.
- Serum electrolytes: Hypochloremia, hypokalemia. |
- IV fluids with normal saline to replace volume and chloride.
- Potassium supplementation. - Stop nasogastric suction or treat vomiting. |
Diuretic Use (Loop or Thiazide Diuretics) |
- Muscle weakness, fatigue, signs of dehydration.
- Symptoms may include lightheadedness or orthostatic hypotension. |
- ABG: Elevated pH, elevated bicarbonate.
- Serum electrolytes: Hypokalemia, hypochloremia. - Urine chloride: Low if volume depletion is present. |
- Discontinue or adjust diuretic therapy.
- IV fluids (normal saline) to correct dehydration. - Potassium and chloride supplementation. |
Hyperaldosteronism (Primary or Secondary) |
- Hypertension, muscle weakness, and increased thirst.
- Polyuria and polydipsia (due to excessive aldosterone). |
- ABG: Elevated pH, elevated bicarbonate.
- Serum electrolytes: Hypokalemia, elevated sodium. - Renin and aldosterone levels: Elevated aldosterone with suppressed renin in primary hyperaldosteronism. |
- Treat the underlying cause (e.g., adrenal adenoma in primary hyperaldosteronism).
- Aldosterone antagonists (e.g., spironolactone). - Correct electrolyte imbalances. |
Excessive Bicarbonate Administration |
- Symptoms of alkalosis, including muscle cramps, confusion, and paresthesia.
- Signs of volume overload if bicarbonate is given with IV fluids. |
- ABG: Elevated pH, elevated bicarbonate.
- Serum electrolytes: Hypernatremia and hypokalemia may be present. |
- Stop bicarbonate administration.
- Treat underlying cause of acidosis that led to bicarbonate use. - Correct electrolyte imbalances. |
Hypokalemia |
- Muscle weakness, fatigue, palpitations.
- Cardiac arrhythmias (e.g., premature ventricular contractions). |
- ABG: Metabolic alkalosis (elevated pH, elevated bicarbonate).
- Serum electrolytes: Hypokalemia. - ECG: Flattened T waves, U waves, and possible arrhythmias. |
- Potassium replacement (oral or IV depending on severity).
- Treat underlying cause of hypokalemia (e.g., diuretics, vomiting). |
Contraction Alkalosis |
- Occurs in dehydration due to loss of fluid, especially from vomiting or diuretics.
- Symptoms of dehydration and volume depletion (dry mucous membranes, low blood pressure). |
- ABG: Elevated pH, elevated bicarbonate.
- Serum electrolytes: Hypokalemia, hypochloremia. - Urine chloride: Low. |
- IV fluids with normal saline to correct dehydration.
- Potassium and chloride supplementation. - Treat underlying cause of fluid loss. |
Milk-Alkali Syndrome |
- Nausea, vomiting, polyuria, and confusion.
- Hypercalcemia-related symptoms such as weakness, kidney stones, or bone pain. |
- ABG: Metabolic alkalosis.
- Serum electrolytes: Hypercalcemia, elevated bicarbonate. - Serum creatinine: May show renal impairment. |
- Stop calcium or antacid supplementation.
- IV fluids to promote calcium excretion. - Treat hypercalcemia if severe (e.g., with bisphosphonates). |