Profound Metabolic Alkalosis

44 year old presents by ambulance with altered conscious state...

PMx - Alcoholic liver disease, sepsis, ischaemic hepatitis

+ Describe the Blood Gas

  • Severe, life threatening metabolic alkalosis
  • Concurrent respiratory alkalosis (CO2 lower than expected)
  • Polycythaemia
  • Severe hypokalaemia
  • Severe hyponatraemia

Expected pCO2 = 0.7 [HCO3] + 20 mmHg (range: +/- 5)
In this case it would be expected to be 59.9mmHg.

+ What are the potential causes of metabolic alkaosis?

  • Addition of Base to ECF
  • Chloride Depletion (Loss of gastric acid (vomiting, NG drainage) and diuretic use account for 90% of clinical cases of metabolic alkalosis)
  • Potassium depletion
  • Laxative abuse
  • Severe hypoalbumiaemia

Source -