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Symptoms and Signs – Differential Diagnosis of Alkalosis
Metabolic
GI loss of H+
Vomiting, laxative abuse, villous adenoma, VIPoma
Renal loss of H+
Increased Mineralocorticoid activity (stimulates H+ secretion):
Hyperaldosteronism
Increased Glucocorticoids: Cushing's syndrome, liquorice (inhibits 11-hydroxysteroid
dehydrogenase and reduced glucocorticoid metabolism)
increased Na+ delivery to distal nephron
Diuretics: thiazides and loop diuretics (also increased aldosterone secretion)
Bartter's syndrome, Gitelman's syndrome
Intracellular shift of H+
Hypokalaemia (also note that the above causes of GI/renal loss of H+, also induce
K+ loss)
Other
Compensation for respiratory acidosis
Excessive alkali ingestion (e.g. increased sodium bicarbonate administration in treatment
of acidotic states)
Fulminant hepatic failure (failure to synthesize urea and neutralize bicarbonate
derived from amino acid metabolism)
Respiratory
Hyperventilation:
Physiological (anxiety, pain, fever, pregnancy, high altitude
Mechanical overventilation
Respiratory failure (type I): asthma, COPD, pneumonia, pulmonary oedema,
pulmonary embolism, ARDS, fibrosing alveolitis, right -, left shunt
Salicylate poisoning, CO poisoning
CNS disease (CVA, infection, tumour, trauma)
Others: liver failure (acute), Gram -ve septicaemia
Metabolic
GI loss of H+
Vomiting, laxative abuse, villous adenoma, VIPoma
Renal loss of H+
Increased Mineralocorticoid activity (stimulates H+ secretion):
Hyperaldosteronism
Increased Glucocorticoids: Cushing's syndrome, liquorice (inhibits 11-hydroxysteroid
dehydrogenase and reduced glucocorticoid metabolism)
increased Na+ delivery to distal nephron
Diuretics: thiazides and loop diuretics (also increased aldosterone secretion)
Bartter's syndrome, Gitelman's syndrome
Intracellular shift of H+
Hypokalaemia (also note that the above causes of GI/renal loss of H+, also induce
K+ loss)
Other
Compensation for respiratory acidosis
Excessive alkali ingestion (e.g. increased sodium bicarbonate administration in treatment
of acidotic states)
Fulminant hepatic failure (failure to synthesize urea and neutralize bicarbonate
derived from amino acid metabolism)
Respiratory
Hyperventilation:
Physiological (anxiety, pain, fever, pregnancy, high altitude
Mechanical overventilation
Respiratory failure (type I): asthma, COPD, pneumonia, pulmonary oedema,
pulmonary embolism, ARDS, fibrosing alveolitis, right -, left shunt
Salicylate poisoning, CO poisoning
CNS disease (CVA, infection, tumour, trauma)
Others: liver failure (acute), Gram -ve septicaemia
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