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Metabolic alkalosis is caused by an imbalance of acids and bases in the body, resulting in an increase in blood pH and bicarbonate levels. Causes include fluid loss, endocrine disorders, electrolyte abnormalities, and licorice ingestion. Diagnosis involves a thorough history and laboratory studies.
Metabolic alkalosis is a condition in which the balance of acids and bases in the body is off and is characterized by an increase in blood pH and an increase in the level of bicarbonate in the blood. One cause of metabolic alkalosis is loss of fluid from the body, whether by vomiting or other means. Endocrinological abnormalities, including conditions known as Cushing’s syndrome and Conn’s disease, can cause this condition. Other causes may include electrolyte abnormalities and ingestion of licorice. Determining the cause of metabolic alkalosis in a given patient relies on obtaining a detailed history and interpreting several laboratory studies.
Conditions in which the body loses fluid can cause metabolic alkalosis. With vomiting, patients lose the acidic fluid typically found in the stomach and this can lead to an alkaloid state. Similarly, loss of stomach fluids from using a nasogastric tube that empties stomach contents can also cause alkalosis. The use of diuretics – drugs that increase urine output – can reduce the body’s blood volume and cause an actual increase in the concentration of bicarbonate in the blood, leading to metabolic alkalosis.
Another of the causes of metabolic alkalosis are disorders of the endocrine system. Elevated levels of the hormones aldosterone or cortisol can lead to increased renal excretion of hydrogen ions, which are acidic, thus leading to alkalosis. Patients with these conditions typically also have elevated blood pressure. When patients have narrowing of the blood vessel leading to the kidney, they may develop a similar picture because this condition causes aldosterone levels to rise in the body.
There are a number of other causes of metabolic alkalosis. Having low levels of magnesium or potassium in your blood can lead to this condition. Another cause is a rare inherited disorder that affects kidney function, known as Bartter syndrome. Excessive ingestion of licorice can also cause metabolic alkalosis.
Determining which of the causes of metabolic alkalosis is present in a given patient involves taking a thorough history and interpreting a variety of laboratory studies. The patient’s recent history, including medication use and symptoms experienced, is often very helpful in making a diagnosis. Checking the chloride concentration in the urine also helps distinguish between different causes of metabolic alkalosis. Patients with low urine chloride levels are likely to have a condition where the body loses fluid. High urine chloride indicates an endocrine system disorder.
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