Affiliation:
1. Department of Medicine, University of Vermont Col lege of Medicine, Burlington, VT.
Abstract
Metabolic alkalosis is a common acid-base disturbance in critically ill patients. In this review we discuss the approach to diagnosis and management of this disorder; particular emphasis is given to the causes most com monly responsible for alkalosis in critical care medicine. We present rules for (1) identifying the presence of metabolic alkalosis, ( 2 ) determining whether the disor der is simple or complicated by a second acid-base dis turbance, and (3) determining the cause: The causes are subdivided into three major groups: Chloride-respon sive, chloride-resistant, and alkali administration. The pathogenesis of each type of alkalosis is discussed sep arately, although we stress that more than one cause may be responsible in critically ill patients. The patho logical consequences of metabolic alkalosis and ap proaches to treatment are reviewed. The major issues relating to the critically ill patient are (1) identification and removal of exogenous sources of alkali, (2) iden tification and minimization of HCl losses or selective NaCl losses, and (3) maneuvers to reduce serum HCO 3 concentration without producing extracellular fluid volume overload.
Subject
Critical Care and Intensive Care Medicine
Cited by
20 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献