Metabolic alkalosis differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
Line 997: | Line 997: | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Nephrology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Primary care]] | |||
[[Category: |
Revision as of 21:52, 6 August 2018
Metabolic alkalosis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Metabolic alkalosis differential diagnosis On the Web |
American Roentgen Ray Society Images of Metabolic alkalosis differential diagnosis |
Risk calculators and risk factors for Metabolic alkalosis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
Metabolic alkalosis might be consequence of several conditions such as exogenous HCO3− loads, medications and poisoning, gastrointestinal, renal, endocrine, and systemic diseases.
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[1] | − | + | − | − | − | + | − | + | ↓ | − | ↑ | ↑ | ↓ | ↓ | ↓ | ↓ | ↑ | Nl | Nl | ↑ | ↑ | Nl | Clinical manifestations |
| |
Milk−alkali syndrome[2] | − | + | − | + | − | + | − | + | ↓ | + | ↑ | ↑ | ↓ | ↓ | ↓ | ↓ | ↑ | ↓ | ↑ | ↑ | ↑ | Nl | Clinical manifestationsk + exclusion of other causes of hypercalcemia |
| ||
Transfusion[3] | − | + | − | − | ± | ± | − | + | ↓ | − | ↑ | ↑ | ↓ | ↓ | ↓/↑ | ↓ | ↓ | ↑ | ↑ | Nl to ↑ | Nl to ↑ | Nl | History of administration of large quantities of blood products that contain sodium citrate |
| ||
Drugs/Medication | Chloruretic diuretics[4] | + | − | + | + | − | − | − | − | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl to ↑ | Nl to ↑ | ↑ | History of diuretic use | ||
Penicillin[5] | + | − | − | − | − | − | − | − | Nl | − | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | ↓ | ↑ | Nl | Nl | Nl | History of penicillin use |
| ||
Licorice[6][7] | + | − | − | + | − | − | − | + | Nl to ↑ | − | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl to ↑ | Nl to ↑ | Nl | Clinical manifestations | |||
Laxative abuse[8] | + | − | + | − | − | − | ± | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | ↑ | ↑ | Nl to ↑ | Nl | ↓ | High level of suspicion |
| ||
Antacids[9][10] |
|
+ | + | − | − | − | − | − | − | Nl | − | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | ↑ | Nl | Nl to ↑ | Nl to ↑ | Nl | Clinical manifestations |
| |
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[11] | + | − | + | − | ± | − | − | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl to ↑ | Nl | ↓ | Clinical manifestations |
| |
Nasogastric tube suction[12] | + | − | + | − | − | − | − | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl to ↑ | Nl | ↓ | Clinical manifestations | |||
Zollinger−Ellison syndrome[13] | + | − | + | − | − | − | − | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl to ↑ | Nl | ↓ | Serum gastrin concentration + secretin stimulation test |
| ||
Bulimia nervosa[14] | + | − | + | − | − | − | ± | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↓ | Nl | ↓ | ↑ | Nl to ↑ | Nl | ↓ | High level of suspicion |
| ||
Congenital chloridorrhea[15] | + | − | + | − | − | − | ± | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↓ | ↓ | ↓ | ↑ | Nl to ↑ | Nl to ↑ | Nl to ↑ | Clinical manifestations+ lab findings |
| ||
Pyloric stenosis[16] | + | − | + | − | − | − | − | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↓ ↑ | Nl | Nl | ↑ | Nl to ↑ | Nl | ↓ | Physical exam + imaging |
| ||
Villous adenoma[17] | + | − | + | − | − | − | − | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↓ | ↓ | ↓ | ↑ | Nl to ↑ | Nl | ↑ | Colonoscopy | |||
Gastrocystoplasty[18] | − | − | + | − | − | − | + | − | ↓ | − | ↑ | ↑ | Nl | ↓ | Nl | Nl | Nl | Nl | Nl | Nl to ↑ | Nl to ↑ | Nl | History of operation | |||
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 | Posthypercapnic state[19] | − | − | + | + | − | ± | − | − | Nl | − | ↑ | ↑↑ | ↓ | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl | Nl | Nl | Lab findings |
| |
Hypomagnesemia[20] | + | − | − | − | − | − | − | − | Nl | − | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl | Nl | Nl | Lab findings |
| ||
Hypokalemia[21] | + | − | − | − | − | − | − | − | Nl | − | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | Nl | ↑ | Nl | Nl | Nl | Lab findings |
| ||
Bartter's syndrome[22] | + | − | − | + | − | − | − | − | Nl | + | ↑ | ↑ | Nl | ↓ | ↓↓ | ↓ | ↓ | Nl | ↑ | Nl to ↑ | Nl to ↑ | Nl | Genetic testing | |||
Gitelman’s syndrome[23][24] | + | − | − | + | − | − | − | − | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓↓ | ↓ | Nl | ↓ | ↑ | Nl | Nl | Nl | Genetic testing |
| ||
Renal artery stenosis[25] | + | − | + | − | − | + | + | + | ↑ | + | ↑ | ↑ | ↓ | ↓ | ↑ | ↓ | ↑ | Nl | ↑ | ↑ | ↑ | Nl | Clinical manifestations+ imaging |
| ||
Liddle syndrome[26] | + | − | − | + | − | − | − | − | ↑ | + | ↑ | ↑ | Nl | ↓ | ↓↓ | ↓ | Nl | ↓ | ↑ | Nl | Nl | Nl | Genetic testing |
| ||
Renal tumors[27] | + | − | + | − | − | + | + | + | ↑ | + | ↑ | ↑ | ↓ | ↓ | ↑ | ↓ | ↑ | Nl | ↑ | ↑ | ↑ | Nl | Biopsy |
| ||
Endocrine | Cushing's syndrome[28] | + | − | + | − | − | − | + | − | ↑ | + | ↑ | ↑ | Nl | ↓ | ↑ | ↓ | ↑ | Nl | ↓ | ↑ | ↑ | Nl | 24−hour urinary cortisol excretion + low−dose dexamethasone suppression test | ||
Hyperaldosteronism | Primary[29] | + | − | + | − | − | − | + | − | ↑ | + | ↑ | ↑ | Nl | ↓ | Nl to ↓ | ↓ | ↑ | Nl | ↓ | ↑ | ↑ | Nl | Lab findings |
| |
Secondary[30] | + | − | + | − | − | + | + | + | ↑ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↑ | Nl | ↓ | ↑ | ↑ | ↑ | Nl | Lab findings |
| ||
Congenital adrenal hyperplasia | 11β−Hydroxylase deficiency[31] | − | − | − | + | − | − | + | − | ↑ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↓ | ↑ | Nl | ↓ | Nl | Nl | Nl | Genetic testing |
| |
17α−Hydroxylase deficiency[32] | − | − | − | + | − | − | + | − | ↑ | + | ↑ | ↑ | Nl | ↓ | ↓ | ↓ | ↑ | Nl | ↓ | Nl | Nl | Nl | Genetic testing |
| ||
Systemic | Cystic fibrosis[33] | + | − | + | − | − | + | − | + | ↓ | + | ↑ | ↑ | Nl | ↓ | ↓ | Nl | Nl | Nl | ↑ | Nl to ↑ | Nl | ↑ | Genetic testing |
| |
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 |
References
- ↑ Máttar, João A.; Weil, Max Harry; Shubin, Herbert; Stein, Leon (1974). "Cardiac arrest in the critically III". The American Journal of Medicine. 56 (2): 162–168. doi:10.1016/0002-9343(74)90593-2. ISSN 0002-9343.
- ↑ Abreo, Kenneth (1993). "The Milk-Alkali Syndrome". Archives of Internal Medicine. 153 (8): 1005. doi:10.1001/archinte.1993.00410080065011. ISSN 0003-9926.
- ↑ Gupta M, Wadhwa NK, Bukovsky R (January 2004). "Regional citrate anticoagulation for continuous venovenous hemodiafiltration using calcium-containing dialysate". Am. J. Kidney Dis. 43 (1): 67–73. PMID 14712429.
- ↑ Luke, R. G.; Galla, J. H. (2012). "It Is Chloride Depletion Alkalosis, Not Contraction Alkalosis". Journal of the American Society of Nephrology. 23 (2): 204–207. doi:10.1681/ASN.2011070720. ISSN 1046-6673.
- ↑ Zaki, SyedAhmed; Lad, Vijay (2011). "Piperacillin-tazobactam-induced hypokalemia and metabolic alkalosis". Indian Journal of Pharmacology. 43 (5): 609. doi:10.4103/0253-7613.84986. ISSN 0253-7613.
- ↑ Meltem, Akkas Camkurt; Figen, Coskun; Nalan, Metin Aksu; Mahir, Kunt; Sebnem, Bozkurt; Mehlika, Isildak; Kasim, Kilic Ahmet; Miyase, Bayraktar (2009). "A hypokalemic muscular weakness after licorice ingestion: a case report". Cases Journal. 2 (1): 8053. doi:10.4076/1757-1626-2-8053. ISSN 1757-1626.
- ↑ Lin, Shih-Hua; Yang, Sung-Sen; Chau, Tom; Halperin, Mitchell L. (2003). "An Unusual Cause of Hypokalemic Paralysis: Chronic Licorice Ingestion". The American Journal of the Medical Sciences. 325 (3): 153–156. doi:10.1097/00000441-200303000-00008. ISSN 0002-9629.
- ↑ Roerig, James L.; Steffen, Kristine J.; Mitchell, James E.; Zunker, Christie (2010). "Laxative Abuse". Drugs. 70 (12): 1487–1503. doi:10.2165/11898640-000000000-00000. ISSN 0012-6667.
- ↑ Sahani, Mandeep M.; Brennan, John F.; Nwakanma, Chukwuemeka; Chow, May T.; Ing, Todd S.; Leehey, David J. (2001). "Metabolic Alkalosis in a Hemodialysis Patient After Ingestion of a Large Amount of an Antacid Medication". Artificial Organs. 25 (4): 313–315. doi:10.1046/j.1525-1594.2001.06714.x. ISSN 0160-564X.
- ↑ Vanpee, Dominique; Delgrange, Etienne; Gillet, Jean-Bernard; Donckier, Julian (2000). "Ingestion of antacid tablets (Rennie®) and acute confusion". The Journal of Emergency Medicine. 19 (2): 169–171. doi:10.1016/S0736-4679(00)00206-7. ISSN 0736-4679.
- ↑ Gan, Tong J.; Meyer, Tricia; Apfel, Christian C.; Chung, Frances; Davis, Peter J.; Eubanks, Steve; Kovac, Anthony; Philip, Beverly K.; Sessler, Daniel I.; Temo, James; Tram??r, Martin R.; Watcha, Mehernoor (2003). "Consensus Guidelines for Managing Postoperative Nausea and Vomiting". Anesthesia & Analgesia: 62–71. doi:10.1213/01.ANE.0000068580.00245.95. ISSN 0003-2999.
- ↑ Gilbertson, Heather Ruth; Rogers, Elizabeth Jessie; Ukoumunne, Obioha Chukwunyere (2011). "Determination of a Practical pH Cutoff Level for Reliable Confirmation of Nasogastric Tube Placement". Journal of Parenteral and Enteral Nutrition. 35 (4): 540–544. doi:10.1177/0148607110383285. ISSN 0148-6071.
- ↑ Hung, Patrick D.; Schubert, Mitchell L.; Mihas, Anastasios A. (2003). "Zollinger-Ellison syndrome". Current Treatment Options in Gastroenterology. 6 (2): 163–170. doi:10.1007/s11938-003-0017-6. ISSN 1092-8472.
- ↑ Shapiro, Jennifer R.; Berkman, Nancy D.; Brownley, Kimberly A.; Sedway, Jan A.; Lohr, Kathleen N.; Bulik, Cynthia M. (2007). "Bulimia nervosa treatment: A systematic review of randomized controlled trials". International Journal of Eating Disorders. 40 (4): 321–336. doi:10.1002/eat.20372. ISSN 0276-3478.
- ↑ Wedenoja, S.; HãGlund, P.; Holmberg, C. (2010). "Review article: the clinical management of congenital chloride diarrhoea". Alimentary Pharmacology & Therapeutics. 31 (4): 477–485. doi:10.1111/j.1365-2036.2009.04197.x. ISSN 0269-2813. C1 control character in
|last2=
at position 3 (help) - ↑ Bakal, Unal; Sarac, Mehmet; Aydin, Mustafa; Tartar, Tugay; Kazez, Ahmet (2016). "Recent changes in the features of hypertrophic pyloric stenosis". Pediatrics International. 58 (5): 369–371. doi:10.1111/ped.12860. ISSN 1328-8067.
- ↑ Gennari, F. J.; Weise, W. J. (2008). "Acid-Base Disturbances in Gastrointestinal Disease". Clinical Journal of the American Society of Nephrology. 3 (6): 1861–1868. doi:10.2215/CJN.02450508. ISSN 1555-9041.
- ↑ Kurzrock, Eric A.; Baskin, Laurence S.; Kogan, Barry A. (1998). "GASTROCYSTOPLASTY: LONG-TERM FOLLOWUP". The Journal of Urology. 160 (6): 2182–2186. doi:10.1016/S0022-5347(01)62289-4. ISSN 0022-5347.
- ↑ Banga, Amit; Khilnani, G. C. (2009). "Post-hypercapnic Alkalosis is Associated with Ventilator Dependence and Increased ICU stay". COPD: Journal of Chronic Obstructive Pulmonary Disease. 6 (6): 437–440. doi:10.3109/15412550903341448. ISSN 1541-2555.
- ↑ Elisaf M, Milionis H, Siamopoulos KC (1997). "Hypomagnesemic hypokalemia and hypocalcemia: clinical and laboratory characteristics". Miner Electrolyte Metab. 23 (2): 105–12. PMID 9252977.
- ↑ Galla JH (February 2000). "Metabolic alkalosis". J. Am. Soc. Nephrol. 11 (2): 369–75. PMID 10665945.
- ↑ Simon, David B.; Karet, Fiona E.; Hamdan, Jahed M.; Pietro, Antonio Di; Sanjad, Sami A.; Lifton, Richard P. (1996). "Bartter's syndrome, hypokalaemic alkalosis with hypercalciuria, is caused by mutations in the Na–K–2CI cotransporter NKCC2". Nature Genetics. 13 (2): 183–188. doi:10.1038/ng0696-183. ISSN 1061-4036.
- ↑ Fremont, Oliver T.; Chan, James C. M. (2012). "Understanding Bartter syndrome and Gitelman syndrome". World Journal of Pediatrics. 8 (1): 25–30. doi:10.1007/s12519-012-0333-9. ISSN 1708-8569.
- ↑ Colussi G, Macaluso M, Brunati C, Minetti L (1994). "Calcium metabolism and calciotropic hormone levels in Gitelman's syndrome". Miner Electrolyte Metab. 20 (5): 294–301. PMID 7700218.
- ↑ Safian, Robert D.; Textor, Stephen C. (2001). "Renal-Artery Stenosis". New England Journal of Medicine. 344 (6): 431–442. doi:10.1056/NEJM200102083440607. ISSN 0028-4793.
- ↑ Salih, Mahdi; Gautschi, Ivan; van Bemmelen, Miguel X.; Di Benedetto, Michael; Brooks, Alice S.; Lugtenberg, Dorien; Schild, Laurent; Hoorn, Ewout J. (2017). "A Missense Mutation in the Extracellular Domain ofαENaC Causes Liddle Syndrome". Journal of the American Society of Nephrology. 28 (11): 3291–3299. doi:10.1681/ASN.2016111163. ISSN 1046-6673.
- ↑ Lasseigne, Brittany N.; Brooks, James D. (2018). "The Role of DNA Methylation in Renal Cell Carcinoma". Molecular Diagnosis & Therapy. doi:10.1007/s40291-018-0337-9. ISSN 1177-1062.
- ↑ Araujo Castro, Marta; Marazuela Azpiroz, Mónica (2018). "Two types of ectopic Cushing syndrome or a continuum? Review". Pituitary. doi:10.1007/s11102-018-0894-2. ISSN 1386-341X.
- ↑ Martell-Claros, Nieves; Abad-Cardiel, María; Alvarez-Alvarez, Beatriz; García-Donaire, José A.; Pérez, Cristina Fernández (2015). "Primary aldosteronism and its various clinical scenarios". Journal of Hypertension. 33 (6): 1226–1232. doi:10.1097/HJH.0000000000000546. ISSN 0263-6352.
- ↑ Monticone S, Losano I, Tetti M, Buffolo F, Veglio F, Mulatero P (May 2018). "Diagnostic approach to low renin hypertension". Clin. Endocrinol. (Oxf). doi:10.1111/cen.13741. PMID 29758100.
- ↑ Baş F, Toksoy G, Ergun-Longmire B, Uyguner ZO, Abalı ZY, Poyrazoğlu Ş, Karaman V, Avcı Ş, Altunoğlu U, Bundak R, Karaman B, Başaran S, Darendeliler F (April 2018). "Prevalence, clinical characteristics and long-term outcomes of classical 11 β-hydroxylase deficiency (11BOHD) in Turkish population and novel mutations in CYP11B1 gene". J. Steroid Biochem. Mol. Biol. doi:10.1016/j.jsbmb.2018.04.001. PMID 29626607.
- ↑ Goldsmith, Oliver; Solomon, David H.; Horton, Richard (1967). "Hypogonadism and Mineralocorticoid Excess". New England Journal of Medicine. 277 (13): 673–677. doi:10.1056/NEJM196709282771302. ISSN 0028-4793.
- ↑ Bates CM, Baum M, Quigley R (February 1997). "Cystic fibrosis presenting with hypokalemia and metabolic alkalosis in a previously healthy adolescent". J. Am. Soc. Nephrol. 8 (2): 352–5. PMID 9048354.