Treatment of Metabolic alkalosis

Treatment of Metabolic alkalosis

1. Volume depletion patient
-Rx Volume replacement
-if cause from diuretic induce -> Rx K sparing Spironolactone, amiloride,triamterene

2. Volume repletion patient
-Cause from mineralocorticoid excess
-Rx Spironolactone

3.Miscellaneous cause
-Post hypercapnic metabolic alkalosis
1.Acteazolamide (CAI) ตรง intercalated cell inh secretion of H+
Aceatazolamide 500 mg reduce serum HCO3 6mmol/L
Beware K loss becase inh H+/K+
2.NH4Cl and arginine ห้ามให้ใน liver disease because induce hepatic enceph
3.Acid infusion 100-200 mEq/L of HCL via central line
Beware of tissue necrosis and acid induce hemolysis
4.Hemodialysis with Low HCO3 dialysate

Noriaki Kurimoto