{"id":8695,"date":"2012-02-20T10:04:13","date_gmt":"2012-02-20T15:04:13","guid":{"rendered":"https:\/\/crashingpatient.com\/?p=8695"},"modified":"2012-02-20T10:18:05","modified_gmt":"2012-02-20T15:18:05","slug":"alkalemia-metabolic-and-respiratory-alkalosis","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/","title":{"rendered":"Alkalemia &#8211; Metabolic and Respiratory Alkalosis"},"content":{"rendered":"<h2><span class=\"ez-toc-section\" id=\"Alkalemia\"><\/span>Alkalemia<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>hypokalemia (and sensitization to dig related arrhythmias)<\/p>\n<p>reduction of ionized calcium leading to neurologic symptoms<\/p>\n<p>Stimulates anaerobic metabolism<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Metabolic_Alkalosis\"><\/span>Metabolic Alkalosis<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Plasma bicarb&gt;45<\/p>\n<p>seek to lower it to<\/p>\n<ul>\n<li>Nasogastric Suction\/Vomiting<\/li>\n<li>Diuretics-from increased loss of urinary electrolytes and water. Cl loss balanced by reabsorbtion of bicarb, H+ moves into cells to allow eflux of K. Mg loss promotes loss of K<\/li>\n<li>Hyperaldosteronism<\/li>\n<li>Volume depletion: contraction alkalosis. Stimulation of renin-angiotensin to waste H+<\/li>\n<li>Organic Ion administration-Lactate, acetate, and citrate. (need 8 units of blood to affect pH.)<\/li>\n<li>Posthypercapnia-if chronic<\/li>\n<\/ul>\n<p>Contraction alkalosis because relatively more bicarb in a smaller space (sketchy concept)<\/p>\n<p>Patients need NaCl and Potassium Chloride<\/p>\n<p>Can give hydrochloric acid<\/p>\n<p>need 0.1 to 0.2 N solution (100 to 200 mmol per liter)<\/p>\n<p>0.5 * kg * desired reduction in bicarb=mmol of acid needed<\/p>\n<p>Volume in L of 0.1 M=desired mEQ\/100 mEq\/L<\/p>\n<p>Using 0.2 desired mEq\/200 mEq\/L<\/p>\n<p>Infuse at 0.2 mEq\/kg\/hour<\/p>\n<p>&nbsp;<\/p>\n<p>Cl responsive if urine Cl is<\/p>\n<p>Vomiting, gastric drainage, <strong>diuretics<\/strong>, lactate, acetate<\/p>\n<p>&nbsp;<\/p>\n<p>Cl Resistant if Cl&gt;20 mEq (Mineralcorticoid excess or K depletion)<\/p>\n<p>excess mineralcorticoid (cushings, hyperaldo, ACTH tumors, licorice, renal art stenosis, steroids,)<\/p>\n<p>severe k deficiency<\/p>\n<p>mag deficiency<\/p>\n<p>&nbsp;<\/p>\n<p>associated with high mortality (South Med J 1987;80(6):729)<\/p>\n<h4>3 Causes from a Renal Perspective<\/h4>\n<p>from Joel Topf<\/p>\n<ol>\n<li>Conditions with chloride depletion with secondary collecting duct hydrogen stimulation<\/li>\n<li>Conditions with primary stimulation of the collecting duct hydrogen secretion<\/li>\n<li>Increased Alakli Intake with renal failure<\/li>\n<\/ol>\n<p><a href=\"https:\/\/crashingpatient.com\/wp-content\/uploads\/2012\/02\/scrnsht-0000.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-8701\" title=\"scrnsht-0000\" src=\"https:\/\/crashingpatient.com\/wp-content\/uploads\/2012\/02\/scrnsht-0000-150x150.png\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Respiratory_alkalosis\"><\/span>Respiratory alkalosis:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong><em>Acute<\/em><\/strong><\/p>\n<p>a.HCO3- drops 1 to 3.5 mEq\/L for every 10 mm Hg drop in P CO2 .<\/p>\n<p>Limit of compensation: bicarbonate is rarely below 18 mEq\/L.<\/p>\n<p><strong><em>Chronic (renal compensation starts within 6 hours and is usually at a steady state by 1.5 to 2 days)<\/em><\/strong><\/p>\n<p>a.HCO3- drops 2 to 5 mEq\/L for every 10 mm Hg drop in P CO2 .<\/p>\n<p>Limit of compensation: bicarbonate is rarely below 12 to 14 mEq\/L.<\/p>\n<h4>Pseudorespiratory Alkalosis<\/h4>\n<p>severely reduced pulmonary perfusion with normal alveolar ventilation (i.e. you&#8217;re bagging a shocked patient)<\/p>\n<p>less CO2 is delivered and more CO2 is extracted (b\/c of poor systemic perfusion and poor relative pulmonary perfusion respectively)<\/p>\n<p>So get arterial eucapnia or even hypocapnia with a severely acidotic and hypercapnic venous and tissue state<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Alkalemia hypokalemia (and sensitization to dig related arrhythmias) reduction of ionized calcium leading to neurologic symptoms Stimulates anaerobic metabolism Metabolic Alkalosis Plasma bicarb&gt;45 seek to lower it to Nasogastric Suction\/Vomiting Diuretics-from increased loss of urinary electrolytes and water. Cl loss balanced by reabsorbtion of bicarb, H+ moves into cells to allow eflux of K. Mg [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[24],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Alkalemia - Metabolic and Respiratory Alkalosis - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/\",\"name\":\"Alkalemia - Metabolic and Respiratory Alkalosis - Crashing Patient\",\"isPartOf\":{\"@id\":\"https:\/\/crashingpatient.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/crashingpatient.com\/wp-content\/uploads\/2012\/02\/scrnsht-0000-150x150.png\",\"datePublished\":\"2012-02-20T15:04:13+00:00\",\"dateModified\":\"2012-02-20T15:18:05+00:00\",\"author\":{\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d\"},\"breadcrumb\":{\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/#primaryimage\",\"url\":\"https:\/\/crashingpatient.com\/wp-content\/uploads\/2012\/02\/scrnsht-0000.png\",\"contentUrl\":\"https:\/\/crashingpatient.com\/wp-content\/uploads\/2012\/02\/scrnsht-0000.png\",\"width\":\"1072\",\"height\":\"767\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/metabolic-disorders\/alkalemia-metabolic-and-respiratory-alkalosis.htm\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/crashingpatient.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Alkalemia &#8211; 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