0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16
978 Metabolic Alkalosis■urine tests:
➣[Na] and [Cl]
differential diagnosis
■decreased EABV, normal or low blood pressure
➣decreased urine [Cl] (<20 mEq/L) and decreased urine [Na] (<20
mEq/L)
remote use of loop or thiazide diuretics
posthypercapneic metabolic alkalosis
vomiting (not active)
villous adenoma
➣decreased urine [Cl] (<20 mEq/L) and increased urine [Na] (>20
mEq/L)
vomiting (active)
excretion of nonreabsorbable anion (ticarcillin, carbenicillin)
➣increased urine [Cl] (>20 mEq/L) and increased urine [Na] (>20
mEq/L)
active diuretic use
Bartter’s syndrome, Gitelman’s syndrome
Mg++deficiency
■increased EABV, hypertension, increased urine [Cl] (>20 mEq/L) and
increased urine [Na] (>20 mEq/L)
➣increased renin, increased aldosterone
malignant hypertension
renal artery stenosis
renin secreting tumor
➣decreased renin and increased aldosterone
adrenal adenoma
bilateral adrenal hyperplasia
glucocorticoid remediable hyperaldosteronism
➣decreased renin and decreased aldosterone (syndromes of
apparent mineralocorticoid excess)
Cushing’s syndrome
11 beta hydroxylase deficiency
acquired 11 beta hydroxylase deficiency
carbenoxolone
licorice or chewing tobacco containing glycyrrhetinic acid
➣Liddle’s syndrome
management
■confirm presence of primary metabolic alkalosis with arterial blood
gas