Alkalotics Anonymous: Severe Metabolic Alkalosis

• Published in: The American journal of medicine Vol. 127; no. 1; pp. 25 - 27
• Main Authors: Marston, Nicholas, MD, Kehl, Devin, MD, Copp, Jonathan, BS, Nourbakhsh, Noureddin, DO, Rifkin, Dena E., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2014; Elsevier Sequoia S.A
• Subjects: Alcohol Drinking - adverse effects; Alcoholism; Alkalosis - blood; Alkalosis - chemically induced; Alkalosis - diagnosis; Alkalosis - etiology; Antacids; Antacids - adverse effects; Bicarbonates - adverse effects; Biomarkers - blood; Diagnosis, Differential; Disease management; Diuretics - adverse effects; Eating; Emergency medical care; Fluid Therapy; Foreign Bodies; Gastritis - drug therapy; Gastritis - etiology; Humans; Hydration; Hypokalemia - complications; Internal Medicine; Laxatives - adverse effects; Male; Mens health; Middle Aged; Mineralocorticoids - adverse effects; Self Medication - adverse effects; Therapy; Vomiting - complications; Vomiting - etiology
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2013.09.006

Marston et al examine the case of a 64-year-old man with severe metabolic alkalosis. He was brought to the emergency department after 3 weeks of decreased oral intake, worsening confusion, and difficulty walking. A decision was made to initiate intravenous hydration with normal saline. This tactic was designed to improve kidney function, allowing diuresis of bicarbonate. The goals of therapy for metabolic alkalosis include correcting the acid-base disturbance, addressing any associated electrolyte abnormalities, and treating the underlying cause. Use of baking soda and other antacids is common in alcoholics and should be seriously considered in patients who present with metabolic alkalosis, especially if a history of alcohol use coincides with a history of reflux, dyspepsia, or upper gastrointestinal bleeding.