Metabolic Alkalosis

(Base Bicarbonate Excess)

Precipitating factors Predisposing factors

 Volume depletion  Long term diuretic therapy

(vomiting, NG suction)  Medical conditions
 Dehydration
 Use of antacids

Metabolic Alkalosis

Extracellular potassium Loss of bicarbonate-poor,

Loss of gastric secretions chloride-rich extracellular fluid
concentration decreases

Hydrogen ion is excreted Potassium ions move out of Contraction of extracellular

the cells fluid volume

Bicarbonate ion is gained in

Hydrogen ions move into Bicarbonate mass is now
the extracellular space
the intracellular space dissolved in a smaller volume
of fluid

Bicarbonate mass is now

dissolved in a smaller volume
of fluid

Decrease in hydrogen ion

concentration

Increase in bicarbonate Rapid renal excretion of

bicarbonate

>pH 7.45
Decrease in HCO3

Decrease in the
stimulation of the
medullary chemoreceptors

A decrease respiratory rate

Carbon dioxide retention is

increased

Carbon dioxide retention is

increased
 Signs and Symptoms
 Tingling of the fingers and toes
 Dizziness
 Hypertonic muscles
 Subsequent headache
 Lethargy
 Neuromuscular excitability
 Sometimes with delirium, tetany, and
seizures.
 Hypoventilation
 Nausea and confusion