What causes metabolic alkalosis?

Updated: Dec 10, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Causes of chloride-responsive alkalosis (urine chloride < 20 mEq/L) include the following:

  • Loss of gastric secretions - Vomiting, NG suction
  • Loss of colonic secretions - Congenital chloridorrhea, villous adenoma
  • Thiazides and loop diuretics (after discontinuation)
  • Posthypercapnia
  • Cystic fibrosis

Causes of chloride-resistant alkalosis (urine chloride >20 mEq/L) with hypertension include the following:

  • Primary hyperaldosteronism - Adrenal adenoma, bilateral adrenal hyperplasia, adrenal carcinoma, glucocorticoid-remediable hyperaldosteronism
  • 11B-HSD2 - Genetic, licorice, chewing tobacco, carbenoxolone
  • CAH - 11-Hydroxylase or 17-hydroxylase deficiency
  • Current use of diuretics in hypertension
  • Cushing syndrome
  • Exogenous mineralocorticoids or glucocorticoids
  • Liddle syndrome
  • Renovascular hypertension

Causes of chloride-resistant alkalosis (urine chloride >20 mEq/L) without hypertension include the following:

  • Bartter syndrome
  • Gitelman syndrome
  • Severe potassium depletion
  • Current use of thiazides and loop diuretics
  • Hypomagnesemia

Other causes include the following:

  • Exogenous alkali administration - Sodium bicarbonate therapy in the presence of renal failure, metabolism of lactic acid or ketoacids
  • Milk-alkali syndrome
  • Hypercalcemia
  • Intravenous penicillin
  • Refeeding alkalosis
  • Massive blood transfusion

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