Metabolic alkalosis occurs with loss of acids from the kidneys or stomach. Kidneys reabsorb and generate more bicarbonate and hence increased net acid excretion.
Causes of critical acid loss include:
- Chronic vomiting
- Cushing’s disease, primary Hypoaldosteronism, and bartter’s syndrome
- Fistulas
- Nasogastric tube drainage or lavage without adequate electrolyte replacement.
- Massive blood transfusion
- Use of steroids and certain diuretics
- Excessive diuretics
Excessive HCO3 retention causing chronic hypercapnia can result from:
- Excessive intake of absorbable alkali
- Excessive intake of bicarbonate of soda or other antacids (usually for treatment of gastritis or peptic ulcer)
- Excessive amounts of I.V fluids with high concentrations of bicarbonate or lactate.
- Respiratory insufficiency
Alterations in extracellular electrolyte levels that can cause metabolic alkalosis include:
- Low chloride (as chloride diffuses out of the cell, hydrogen diffuses into the cell)
- Low plasma potassium causing increased hydrogen ion excretion by the kidneys.
Symptoms of metabolic alkalosis
Loss of acid
- Vomiting, gastric suction, gastrocolic fistula
- Diarrhea in cystic fibrosis (rarely)
- Aciduria secondary to potassium depletion
Excess of base due to
- Administration of absorbable antacids
- Administration of salts of weak acids
- Some vegetarian diets
Potassium depletion
- Gastrointestinal loss
- Lack of potassium intake (e,g, anorexia nervosa, administration of intervenous fluids without potassium supplements for treatment of vomiting).
- Diuretics
- Extracellular volume depletion and chloride depletion
- All forms of mineralocorticoid
- Glycogen deposition
- Potassium losing nephropathy
Presentation
- Hypoventilation and hypoxemia resulting in mental status changes.
- Seizures
- Volume depletion in some cases
- Tachyarrhythmias secondary to associated hypokalmia or hypocalcemia
- Weakness
- Neuromuscular irritability
- Cardiovascular irritability
- Cardiovascular dysfunction
- Signs and symptoms of the primary disease process will also present.
Diagnosis of metabolic alkalosis
- Raised plasma bicarbonate and ph.
- Mild rise in PaCO2
- Hypokalmia with flattened T waves and prominent U waves in ECG.
- Urine pH below 7
- Urine chloride less than 10 mEq/Lit if there is volume depletion and more than 20 mEq/lit in hypocorticism.
- Tetany, apathy and confusion.
Homeopathic treatment for metabolic alkalosis
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat metabolic alkalosis but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat metabolic alkalosis that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of metabolic alkalosis:
Aconite, Aethusa, Antim Crude, Antim Tart, Apis Mel, Argentum Nitricum, Colchicum, Bryonia, Nux Vomica, Ipecauc, Pulsatilla, Veratrum Album, Sulphur, Carbo Veg, and many other medicines.
Hello,
Our daughter has both metabolic alkalosis and respiratory alkalosis, and she has been getting no help at the Mayo Clinic here in the US. They have not helped her find the cause of the alkalosis, even though they diagnosed her back in April of this year. She was only given acetazolomide and methazolomide, both of which never helped, but made her feel worse in some ways. She was not on either of them very long. She was previously a healthy, happy, active young lady 2 years ago, but has gotten worse and we are desperate for help. Her blood gas test was a 7.54 back in April, we don’t know what it is now, because they are painful, so she hasn’t had one since then. We are worried about it rising into the danger zone. We have tried at least 3 naturopaths and one integrative dr here in Az before going to Mayo, because none of them had any idea what she had. Of course none of them took insurance, so it was a lot of money for nothing. Because our daughter is too sick to work, she is living with us. She went to Mayo in desperation, where at least someone was able to give her a diagnosis and take our insurance. However, they have done nothing else to treat the alkalosis but run tests that aren’t giving us a reason for the alkalosis in the first place. None of us has had any of the covid shots, including our daughter. Is there anyone you can recommend here in the US who knows anything about chronic (not acute) alkalosis and how to find the cause so they can treat it? We are so desperate to help our daughter. Thank you in advance for any info you can provide.