Summary about Disease
Metabolic alkalosis is a condition in which the body's pH balance is disturbed, resulting in an increased alkalinity of the blood. This occurs when there is an excess of bicarbonate (a base) in the body, or a loss of acid. It's characterized by a pH greater than 7.45 and a bicarbonate level above 28 mEq/L.
Symptoms
Symptoms can vary widely and may include:
Confusion
Lightheadedness
Numbness or tingling in the extremities
Muscle twitching, spasms, or weakness
Nausea and vomiting
Diarrhea
Tremors
Seizures (in severe cases)
Coma (in severe cases)
Slowed breathing
Causes
Common causes include:
Excessive vomiting or gastric suctioning (leading to loss of stomach acid)
Diuretic use (especially loop and thiazide diuretics, which can lead to loss of acid)
Excessive alkali ingestion (e.g., baking soda, antacids)
Potassium deficiency (hypokalemia)
Hyperaldosteronism (excessive production of aldosterone)
Contraction alkalosis (volume depletion leading to increased bicarbonate concentration)
Rare genetic conditions (e.g., Bartter syndrome, Gitelman syndrome)
Medicine Used
Treatment depends on the underlying cause and severity. Medications may include:
IV fluids: Normal saline (0.9% NaCl) to correct volume depletion and help the kidneys excrete excess bicarbonate.
Potassium chloride (KCl): To correct potassium deficiency.
Acetazolamide (Diamox): A carbonic anhydrase inhibitor that promotes bicarbonate excretion.
Hydrochloric acid (HCl): Administered intravenously in severe cases (rare).
Arginine hydrochloride: In severe cases where saline is contraindicated.
Addressing the underlying cause: Treating hyperaldosteronism, stopping diuretics (if possible), etc.
Is Communicable
No, metabolic alkalosis is not a communicable disease. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Precautions focus on managing underlying conditions and risk factors. These include:
Careful monitoring of diuretic use, especially in patients with heart failure or kidney disease.
Prompt treatment of vomiting or gastric suctioning.
Avoiding excessive use of antacids containing bicarbonate.
Maintaining adequate potassium levels.
Regular monitoring of electrolytes and acid-base balance, especially in individuals at risk.
Educating patients about the potential risks of certain medications and behaviors.
How long does an outbreak last?
Metabolic alkalosis isn't considered an outbreak, as it's not contagious. The duration of the condition depends entirely on the underlying cause and how quickly it's treated. It can resolve within hours to days with appropriate medical intervention.
How is it diagnosed?
Diagnosis involves:
Arterial blood gas (ABG) analysis: Measures blood pH, partial pressure of carbon dioxide (PaCO2), and bicarbonate (HCO3-) levels. Key findings are a pH > 7.45 and HCO3- > 28 mEq/L.
Electrolyte panel: Measures sodium, potassium, chloride, and other electrolytes to identify imbalances.
Clinical history and physical examination: To identify potential causes, such as vomiting, diuretic use, or underlying medical conditions.
Urine chloride: Can help differentiate between different causes of metabolic alkalosis.
Other tests: May be ordered to investigate underlying causes, such as aldosterone levels or renal function tests.
Timeline of Symptoms
The onset and progression of symptoms vary depending on the cause and severity of the alkalosis.
Acute alkalosis: Symptoms can develop rapidly, within hours to days, particularly with severe vomiting or rapid administration of alkali.
Chronic alkalosis: Symptoms may develop more gradually over weeks or months, and may be milder or even absent initially. The timeline is highly variable.
Important Considerations
Metabolic alkalosis can have serious consequences if left untreated, including arrhythmias, seizures, and coma.
Treatment should be directed at addressing the underlying cause.
Rapid correction of chronic metabolic alkalosis can sometimes lead to complications, such as tetany.
Patients with underlying medical conditions, such as heart failure or kidney disease, may be more susceptible to the complications of metabolic alkalosis.
Monitoring electrolyte and acid-base balance is crucial during treatment.