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Renal system anatomy and physiology
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|Arterial blood gas|
metabolic alkalosis with p. 616
metabolic alkalosis p. 616
metabolic alkalosis p. 616
acetazolamide for p. 632
causes of p. 616
Gitelman syndrome p. 610
hyperaldosteronism p. 356
in hypertrophic pyloric stenosis p. 368
loop diuretics p. 632
thiazides p. 633
with bulimia nervosa p. 590
metabolic alkalosis from p. 616
With metabolic alkalosis, “alkalosis” refers to a process that raises blood pH above 7.45, and “metabolic” refers to the fact that it’s caused by an increase in the concentration of bicarbonate HCO3− in the blood.
Normally, blood pH depends on the balance or ratio between the concentration of bases, mainly bicarbonate HCO3−, which increases the pH, and acids, which decrease the pH.
The blood pH needs to be constantly between 7.35 and 7.45.
Now, metabolic alkalosis can typically happen from two main causes - loss of hydrogen H+ ions and gain of HCO3− bicarbonate ions, or, most often, a combination of these two.
Loss of hydrogen H+ ions can occur either from the gastrointestinal tract or from the kidneys.
The first case most commonly happens during vomiting, because the gastric secretions are very acidic, meaning that they have lots of hydrogen H+ ions.
On top of that, normally, as gastric secretions flow into the pancreas, they’re met with HCO3− bicarbonate secretions which neutralize the acid so that the various pancreatic enzymes like trypsin and chymotrypsin, can work effectively.
Another way that hydrogen H+ ions can be lost is through the urine, in the context of having too much of the hormone aldosterone.
This can happen, when there’s an adrenal tumor that secretes excess aldosterone.
The aldosterone makes the α- intercalated cells of the distal convoluted tubule and collecting duct dump out hydrogen H+ ions and reabsorb more bicarbonate HCO3− ions.
The result is that the urine becomes more acidic and the blood becomes more basic.
Now, the second cause - a primary gain of HCO3− bicarbonate ions - is usually caused by an increased reabsorption of HCO3− bicarbonate ions from the kidneys.
There are various things that could stimulate the kidneys to do that.
Metabolic alkalosis is a condition in which the blood pH is above 7.45, following an increase in blood HCO3 concentration to over 27 mEq/L. Common causes of metabolic alkalosis include excessive loss of hydrogen ions like when vomiting, abnormal renal function, loop, and thiazide diuretics, excessive use of antacids, etc. Symptoms of metabolic alkalosis include nausea, vomiting, muscle weakness, and confusion.
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