Alkalosis

Sodium bicarbonate is a gastric antacid that may cause systemic alkalosis on overdose and may contribute to edema owing to sodium retention. It is useful for systemic acidosis because both deficient ions are present in the same molecule, and it can be used topically as a moist paste or in solution as an antipmritic. Sodium bicarbonate also is an ingredient of many effervescent mixtures, alkaline solutions, etc. One gram of NaHCO neutralizes 115 mL 0.1 NHCl. 

Fmit and vegetable juices high in potassium have been recommended to correct hypokalemic alkalosis in patients on diuretic therapy. Apparendy the efficacy of this treatment is questionable. A possible reason for ineffectiveness is the low Ck content of most of these juices. Because Ck is high only in juices in which Na" is high, these have to be excluded (64). 

Ringer s lactate, in which lactate is added to Ringer s solution, is probably the most popular crystalloid (salt) solution for intravenous use in humans. The lactate is gradually converted to sodium bicarbonate within the body so that an uncompensated alkalosis is prevented (13). These crystalloid solutions cannot support life without red cells saline passes rather quickly into the tissue spaces of various organs (14), especially the Hver (15). 

Diuretics are needed to return to normal the expanded extracellular volume that other antihypertensive agents produce, such as fluid retention and blood volume expansion, via compensatory mechanisms of the body. The loss of efficacy of antihypertensive agents can be restored if a diuretic is used concomitandy. In the treatment of hypertension, high ceiling or loop diuretics, such as furosemide, ethacrynic acid, and bumetanide, are no more efficacious than the thiazide-type of diuretics. In fact, these agents cause more side effects, such as dehydration, metaboHc alkalosis, etc, and therefore, should not be used except in situations where rapid elimination of duid volume is cleady indicated. 

The use of CA inhibitors as diuretics is limited by their propensity to cause metabolic acidosis and hypokalemia. Their use can be indicated in patients with metabolic alkalosis and secondary hyperaldosteronism resulting for example from aggressive use of loop diuretics. Furthermore, CA inhibitors are effective dtugs to produce a relatively alkaline urine for the treatment of cysteine and uric acid stones as well as for the accelerated excretion of salicylates. Perhaps the most common use of CA inhibitors is in the treatment of glaucoma. 

Liddle s syndrome is an autosomal dominant disorder that is caused by persistent hyperactivity of the epithelial Na channel. Its symptoms mimic aldosterone excess, but plasma aldosterone levels are actually reduced (pseudoaldosteronism). The disease is characterized by early onset arterial hypertension, hypokalemia, and metabolic alkalosis. 

Levels greater than 400 mcg/mL may result in respiratory alkalosis, hemorrhage, excitement, confusion, asterixis (involuntary jerking movements especially... 

Calcium-containing antacids—rebound hyperacidity, metabolic alkalosis, hypercalcemia, vomiting, confusion, headache, renal calculi, and neurologic impairment... 

Sodium bicarbonate—systemic alkalosis and rebound hypersecretion... 

Sodium and fluid retention, congestive heart failure in susceptible patients, potassium loss, hypokalemic alkalosis, hypertension, hypocalcemia, hypotension or shocklike reactions... 

Administration of protein substrates (amino acids) may result in nausea, fever, flushing of the skin, metabolic acidosis or alkalosis, and decreased phosphorus and calcium blood levels. 

In some instances, excessive oral use may produce nausea and vomiting. Some individuals may use sodium bicarbonate (baking soda) for the relief of gastric disturbances, such as pain, discomfort, symptoms of indigestion, and gas. Prolonged use of oral sodium bicarbonate or excessive doses of IV sodium bicarbonate may result in systemic alkalosis. 

Respiratory alkalosis is the rise in pH associated with excessive respiration. Hyperventilation, which can result from anxiety or high fever, is a common cause. The body may control blood pH during hyperventilation by fainting, which results in slower respiration. An intervention that may prevent fainting is to have a hyperventilating person breathe into a paper bag, which allows much of the respired CX)2 to be taken up again. 

Metabolic alkalosis is the increase in pH resulting from illness or chemical ingestion. Repeated vomiting or the overuse of diuretics can cause metabolic alkalosis. Once again the body compensates, this time by decreasing the rate of respiration. 

Excretion into urine of ammonia produced by renal mbu-lar cells facilitates cation conservation and regulation of acid-base balance. Ammonia production from intracellular renal amino acids, especially glutamine, increases in metabolic acidosis and decreases in metabolic alkalosis. 

In addition, the physician with the aid of the clinical chemist, needs to calculate salt and water requirements for the newborn infant. Of prime importance is the determination of how much sodium bicarbonate is required to correct an acidosis, or in rare cases, how much ammonium chloride might be required to correct an alkalosis ( ). 

Regulator mechanisms of hemoglobin oxygen affinity in acidosis and alkalosis. J Clin Invest (1971), 50,... 

Metabolic alkalosis (citrate hepatically metabolized to bicarbonate)... 

These goals may minimize an overshoot metabolic alkalosis = Remember that ketoacids and lactic acid are metabolized to bicarbonate... 

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