Metabolic alkalosis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S [2]

Overview

Causes of Metabolic Alkalosis are Vomiting, Diarrhea, Diuretics, Cystic Fibrosis, Primary Hyperaldosteronism, Secondary hyperaldosteronism, laxative use, CKD, elactrolyte and nutritional imbalances, Milk-alkali syndrome, Blood transfusion, Genetic diseases for instances Bartter, Liddle, Gitelman syndrome etc. Among them, life threatening causes are loss of gastric acid, excessive use of loop and thiazide diuretics.

Causes

There are several causes of metabolic alkalosis. Life threatening causes of severe metabolic alkalosis (pH 7.55 to 7.65) may result in death (45% to 80%) or permanent disability within 24 hours if left untreated.^[1]

Common Causes

Chloride depletion or Gastrointestinal loss of hydrogen
- GI loss: Vomiting (most commonly seen in pyloric stenosis), NG suction , Zollinger-ellison syndrome, Bulimia.^[2]
- Diuretics: Loop and thiazide diuretics.
- Diarrhea
- Cystic fibrosis.^[3]
- Chloride deficient infant formula.
Potassium depletion or Mineralocorticoids excess or Renal loss of hydrogen
- Dietary potassium depletion.^[4]
- Primary hyperaldosteronism: Conn syndrome or adenoma, hyperplasia, carcinoma, renin or glucocorticoid responsive.
- Secondary hyperaldosteronism: Reno vascular hypertension, edema (cirrhosis, heart failure, nephrotic syndrome), juxtaglomerular cell(renin producing) tumor, renal cell carcinoma, nephroblastoma
- Mineralocorticoid excess due to primary decorticosterone excess (11 beta, 17 alpha hydroxylase deficiency), licorice(glycyrrhetinic acid)
- congenital chloride diarrhea^[5]
- Bartter and Gitelman syndrome. ^[6]
- liddle syndrome</ref> ^[7]
- hemangiopericytoma
- Gastrocystoplasty ^[8]
- Post hypercapneic metabolic alkalosis.

Causes by Organ System

Cardiovascular	Dilated cardiomyopathy, Malignant hypertension, Renovascular hypertension
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Aldosterone, Carbenoxolone, Diuretics, Ethacrynic Acid, Fludrocortisone, Glucocorticoids, Intravenous Pencillins, Laxatives, Lydia Pinkham's vegetable compound, Mineralocorticoids, Pramipexole, Sodium bicarbonate, Tolazoline, Tromethamine
Ear Nose Throat	No underlying causes
Endocrine	Cushing syndrome, Glucocorticoid-remediable hyperaldosteronism, Hyperaldosteronism, 11 beta hydroxylase deficiency, C17-hydroxylase deficiency, Conn syndrome, Bilateral adrenal hyperplasia, Adrenal adenoma, Adrenal carcinoma
Environmental	No underlying causes
Gastroenterologic	Gastric fistula, Villous adenoma, VIPoma, Congenital chloride diarrhea, Cystic fibrosis
Genetic	11 beta hydroxylase deficiency, Bartter syndrome, C17-hydroxylase deficiency, Congenital chloride diarrhea, Cystic fibrosis, Gietelman syndrome, Glucocorticoid receptor defect, Liddle syndrome, SeSAME syndrome
Hematologic	No underlying causes
Iatrogenic	Massive blood transfusion, Nasogastric suction
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Hypercalcemia, Hypokalemia, Hypomagnesemia, Refeeding syndrome, Glucocorticoid receptor defect, Glycyrrhizic acid, Licorice
Obstetric/Gynecologic	No underlying causes
Oncologic	Adrenal adenoma, Adrenal carcinoma, Conn syndrome, Hemangiopericytoma,VIPoma, Juxtaglomerular cell tumor
Opthalmologic	No underlying causes
Overdose / Toxicity	Aldosterone, Carbenoxolone, Diuretics, Fludrocortisone, Glucocorticoids, Intravenous Pencillins, Laxatives, Lydia Pinkham's vegetable compound, Mineralocorticoids, Sodium bicarbonate, Tolazoline, Tromethamine
Psychiatric	No underlying causes
Pulmonary	Cystic fibrosis
Renal / Electrolyte	Bilateral adrenal hyperplasia, Hypokalemic distal renal tubular acidosis, Juxtaglomerular cell tumor, Milk-alkali syndrome, Renovascular hypertension, Bartter syndrome, Gietelman syndrome, Liddle syndrome, Adrenal adenoma, Adrenal carcinoma
Rheum / Immune / Allergy	No underlying causes
Sexual	Cystic fibrosis
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Chewing tobacco, Glycyrrhizic acid, Licorice, Posthypercapnia, Vomiting, Laxatives, Refeeding syndrome, Milk-alkali syndrome

Causes in Alphabetical Order

↑ Tripathy S (October 2009). "Extreme metabolic alkalosis in intensive care". Indian J Crit Care Med. 13 (4): 217–20. doi:10.4103/0972-5229.60175. PMC 2856150. PMID 20436691.
↑ Galla JH, Gifford JD, Luke RG, Rome L (October 1991). "Adaptations to chloride-depletion alkalosis". Am J Physiol. 261 (4 Pt 2): R771–81. doi:10.1152/ajpregu.1991.261.4.R771. PMID 1928424.
↑ Pedroli G, Liechti-Gallati S, Mauri S, Birrer P, Kraemer R, Foletti-Jäggi C, Bianchetti MG (1995). "Chronic metabolic alkalosis: not uncommon in young children with severe cystic fibrosis". Am J Nephrol. 15 (3): 245–50. doi:10.1159/000168839. PMID 7618650.
↑ Sabatini S (March 1996). "The cellular basis of metabolic alkalosis". Kidney Int. 49 (3): 906–17. doi:10.1038/ki.1996.125. PMID 8648937.
↑ Höglund P, Haila S, Socha J, Tomaszewski L, Saarialho-Kere U, Karjalainen-Lindsberg ML, Airola K, Holmberg C, de la Chapelle A, Kere J (November 1996). "Mutations of the Down-regulated in adenoma (DRA) gene cause congenital chloride diarrhoea". Nat Genet. 14 (3): 316–9. doi:10.1038/ng1196-316. PMID 8896562.
↑ Kurtz I (October 1998). "Molecular pathogenesis of Bartter's and Gitelman's syndromes". Kidney Int. 54 (4): 1396–410. doi:10.1046/j.1523-1755.1998.00124.x. PMID 9767561.
↑ Warnock DG (January 1998). "Liddle syndrome: an autosomal dominant form of human hypertension". Kidney Int. 53 (1): 18–24. doi:10.1046/j.1523-1755.1998.00728.x. PMID 9452995.
↑ Plawker MW, Rabinowitz SS, Etwaru DJ, Glassberg KI (August 1995). "Hypergastrinemia, dysuria-hematuria and metabolic alkalosis: complications associated with gastrocystoplasty". J Urol. 154 (2 Pt 1): 546–9. doi:10.1097/00005392-199508000-00066. PMID 7609133.

[pmid20436691-1] Tripathy S (October 2009). "Extreme metabolic alkalosis in intensive care". Indian J Crit Care Med. 13 (4): 217–20. doi:10.4103/0972-5229.60175. PMC 2856150. PMID 20436691.

[pmid1928424-2] Galla JH, Gifford JD, Luke RG, Rome L (October 1991). "Adaptations to chloride-depletion alkalosis". Am J Physiol. 261 (4 Pt 2): R771–81. doi:10.1152/ajpregu.1991.261.4.R771. PMID 1928424.

[pmid7618650-3] Pedroli G, Liechti-Gallati S, Mauri S, Birrer P, Kraemer R, Foletti-Jäggi C, Bianchetti MG (1995). "Chronic metabolic alkalosis: not uncommon in young children with severe cystic fibrosis". Am J Nephrol. 15 (3): 245–50. doi:10.1159/000168839. PMID 7618650.

[pmid8648937-4] Sabatini S (March 1996). "The cellular basis of metabolic alkalosis". Kidney Int. 49 (3): 906–17. doi:10.1038/ki.1996.125. PMID 8648937.

[pmid8896562-5] Höglund P, Haila S, Socha J, Tomaszewski L, Saarialho-Kere U, Karjalainen-Lindsberg ML, Airola K, Holmberg C, de la Chapelle A, Kere J (November 1996). "Mutations of the Down-regulated in adenoma (DRA) gene cause congenital chloride diarrhoea". Nat Genet. 14 (3): 316–9. doi:10.1038/ng1196-316. PMID 8896562.

[pmid9767561-6] Kurtz I (October 1998). "Molecular pathogenesis of Bartter's and Gitelman's syndromes". Kidney Int. 54 (4): 1396–410. doi:10.1046/j.1523-1755.1998.00124.x. PMID 9767561.

[pmid9452995-7] Warnock DG (January 1998). "Liddle syndrome: an autosomal dominant form of human hypertension". Kidney Int. 53 (1): 18–24. doi:10.1046/j.1523-1755.1998.00728.x. PMID 9452995.

[pmid7609133-8] Plawker MW, Rabinowitz SS, Etwaru DJ, Glassberg KI (August 1995). "Hypergastrinemia, dysuria-hematuria and metabolic alkalosis: complications associated with gastrocystoplasty". J Urol. 154 (2 Pt 1): 546–9. doi:10.1097/00005392-199508000-00066. PMID 7609133.

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