Sandbox: wdx causes

Metabolic Alkalosis

Differential diagnosis of metabolic alkalosis is as follow:

Category	Disease		Mechanism				Clinical						Paraclinical												Gold standard diagnosis	Other findings
							Symptoms			Signs			Lab data
													ABG			Chemistry					Enzyme	Renal function
			Hydrogen loss	Accumulation of base	Chloride depletion	Mineralocorticoid excess	Fever	Dyspnea	Edema	Toxic/ill	BP	Dehydration	HCO3−	paCO2	O2	Cl−	K+	Na+	Ca+	Mg+	Renin	Bun	Cr	Urine Cl−
Exogenous HCO3− loads	Acute alkali administration		−	+	−	−	−	+	−	+	↓	−	↑	↑	↓	↓	↓	↓	↑	Nl	Nl	↑	↑	Nl	Clinical	Post treatment of lactic acidosis or ketoacidosis Increased risk of renal stones
	Milk−alkali syndrome		−	+	−	+	−	+	−	+	↓	+	↑	↑	↓	↓	↓	↓	↑	↓	↑	↑	↑	Nl	Clinical + exclusion of other causes of hypercalcemia	Ingestion of large amounts of calcium and absorbable alkali Acute kidney injury
	Transfusion		−	+	−	−	±	±	−	+	↓	−	↑	↑	↓	↓	↓ ↑	↓	↓	↑	↑	Nl to ↑	Nl to ↑	Nl	History of administration of large quantities of blood products that contain sodium citrate	Associated with renal impairment
Drugs/Medication	Chloruretic diuretics	Bumetanide Chlorothiazide Metolazone	+	−	+	+	−	−	−	−	↓	+	↑	↑	Nl	↓	↓	↑	Nl	Nl	↑	Nl to ↑	Nl to ↑	↑	History	Contraction alkalosis
	Penicillin		+																	↓
	Licorice		+																		↓
	Laxative abuse		+
	Antacids	Aluminum hydroxide Sodium polystyrene sulfonate	+	+	-	-	-	-	-	-	Nl	-	↑	↑	Nl	↓	↓	↑	Nl	Nl	Nl	Nl	Nl	Nl	Clinical
Category	Disease		Hydrogen loss	Accumulation of base	Chloride depletion	Mineralocorticoid excess	Fever	Dyspnea	Edema	Toxic/ill	BP	Dehydration	HCO3−	paCO2	O2	Cl−	K+	Na+	Ca+	Mg+	Renin	Bun	Cr	Urine Cl−	Gold standard diagnosis	Other findings
Gastrointestinal origin	Vomiting		+	-	+	-	±	-	-	+	↓	+	↑	↑	Nl	↓	↓	↑	Nl	Nl	↑	Nl to ↑	Nl	↓	Clinical
	Nasogastric tube suction		+		+							+					↓							↓
	Zollinger−Ellison syndrome
	Bulimia		+		+												↓
	Congenital chloridorrhea		+		+
	Pyloric stenosis		+
	Villous adenoma		+		+
	Gastrocystoplasty				+
Category	Disease		Hydrogen loss	Accumulation of base	Chloride depletion	Mineralocorticoid excess	Fever	Dyspnea	Edema	Toxic/ill	BP	Dehydration	HCO3−	paCO2	O2	Cl−	K+	Na+	Ca+	Mg+	Renin	Bun	Cr	Urine Cl−	Gold standard diagnosis	Other findings
Renal origin	HTN																				↑
	Posthypercapnic state				+	+
	Hypomagnesemia										Nl						↓							Nl
	Hypokalemia		+								Nl						↓							Nl
	Bartter's syndrome		+			+					Nl													Nl
	Gitelman’s syndrome		+			+
	Renal artery stenosis										↑										↑			Nl
	Liddle syndrome					+
	Renal tumors
Endocrine	Cushing's syndrome										↑										↓			Nl
	Hyperaldosteronism	Primary									↑						↓				↓			Nl
		Secondary															↓
	Adrenal enzyme defects	11β−Hydroxylase deficiency															↓				↓
		17α−Hydroxylase deficiency															↓				↓
	Hypercalcemia/hypoparathyroidism					+
Systemic	Cystic fibrosis				+
Category	Disease		Hydrogen loss	Accumulation of base	Chloride depletion	Mineralocorticoid excess	Fever	Dyspnea	Edema	Toxic/ill	BP	Dehydration	HCO3−	paCO2	O2	Cl−	K+	Na+	Ca+	Mg+	Renin	Bun	Cr	Urine Cl−	Gold standard diagnosis	Other findings