metabolic alkalosis from diuresis

• related: ICU intensive care unit
• tags: #literature #icu

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• diuresis, NG suction, vomiting leads to loss of chloride ion
• loss of chloride in urine leads to bicarb retention
• this results in metabolic alkalosis
• at the same time, K and hydrogen are excreted from Na delivery to distal tubules, further leading to more alkalosis and loss of K

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• approximate chloride loss by obtaining spot urine chloride and multiply by daily volume output
• e.g. 63 mEq (63 mmol) x net -5L/day = 300 mEq (300 mmol)

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• instead of CA inhibitor acetazolamide (does not correct underlying chloride deficiency), give NaCl to fix chloride loss
• if patient is hypovolemic: give hypertonic 0.9% chloride
• if patient is hypernatremic, give KCL with free water (H2O)¹²³

Links to this note

• ICU intensive care unit
  • metabolic alkalosis from diuresis

Footnotes

1. SEEK Questionnaires ↩

2. Mæhle K, Haug B, Flaatten H, et al. Metabolic alkalosis is the most common acid-base disorder in ICU patients. Crit Care. 2014;18(2):420. PubMed ↩

3. Tinawi M. Pathophysiology, evaluation, and management of metabolic alkalosis. Cureus. 2021;13(1):e12841. PubMed ↩