The Internet Book of Critical Care Podcast IBCC Episode 57 - Metabolic Alkalosis
Sep 26, 2019
The podcast explores metabolic alkalosis and its complications, including cardiac arrhythmia. It discusses the causes and investigations of metabolic alkalosis, emphasizing the importance of urine chloride and potassium levels. The role of the RAS system in metabolic alkalosis and treatment options are also explored, including volume and electrolyte replacement, diuretics, and ventilation changes.
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Managing Compensatory Metabolic Alkalosis
- Don't treat compensatory metabolic alkalosis if the pH is fine.
- Maintaining the chronic baseline bicarbonate level is crucial, especially for COPD patients.
Multimodal Therapy for Metabolic Alkalosis
- Treat metabolic alkalosis with a multimodal approach, not just one thing.
- Consider volume replacement, electrolyte correction, acetazolamide, spironolactone, stopping diuretics, PPIs, vent adjustments, TPN reformulation, dialysis, and IV hydrochloric acid.
Pitfalls in Metabolic Alkalosis Management
- Avoid single-modality therapy for metabolic alkalosis.
- Address all contributing factors, like hypokalemia and hypomagnesemia, alongside volume or chloride issues.