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.
