Pediatric emergency medicine trisk 2882 2882
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TABLE 100.12
CAUSES OF METABOLIC ALKALOSIS
Renal hydrogen loss
Loop or thiazide diuretics
Posthypercapnic alkalosis
Mineralocorticoid excess
Bartter and Gitelman syndromes
Gastrointestinal hydrogen loss
Vomiting
Nasogastric suction
Alkali therapy
Contraction alkalosis
Loop or thiazide diuretics
Cystic fibrosis
Congenital chloridorrhea
Intracellular movement of hydrogen
Hypokalemia
Clinical manifestations. Symptoms associated with metabolic alkalosis
are primarily related to the underlying etiology of the alkalosis or to
associated fluid and electrolyte abnormalities.
Management. The cause of metabolic alkalosis is generally evident from
the history. The evaluation of metabolic alkalosis should include a thorough
history to identify gastrointestinal losses and an account of medications
taken, specifically diuretics and antacids. Serum studies should include
assessment of renal function and electrolyte balance to evaluate for
concurrent abnormalities such as hypokalemia, hypercalcemia, and
abnormalities in serum magnesium, which may support a renal tubulopathy
such as Gitelman syndrome. Urine electrolytes may also be informative. In
patients with metabolic alkalosis and volume contraction, the urine sodium
and chloride concentrations may be dissociated. If the serum bicarbonate
exceeds the renal capacity to conserve, some of the excess bicarbonate will
be excreted with sodium and potassium. This loss of cations will worsen the
sodium deficit and may lead to potassium depletion. Despite metabolic
