Metabolic alkalosis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

Laboratory findings consistent with the diagnosis of Metabolic Alkalosis include ABG (Blood pH is elevated more than 7.45, Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter, Partial pressure of CO2 reduces to combat elevated bicarbonate), high or low Serum aldosterone/Serum renin, and Urine analysis with Urine pH and high or low Urine chloride and sodium.

• Laboratory findings consistent with the diagnosis of Metabolic Alkalosis
  • ABG (Blood pH is elevated more than 7.45, Serum Bicarbonate level is elevate more than 26 mole Equilibrium/Liter, Partial pressure of CO2 reduces to combat elevated bicarbonate)
  • Basic metabolic panel showing electrolytes imbalance.
  • Serum renin and aldosterone:
    • Elevated Renin, Elevated aldosterone:• Hypertensive emergency or urgency or Malignant HTN • Renal HTN • Renin secretin tumor
    • Reduced Renin, Elevated aldosterone:• Aldosterone producing cancer • CAH • Hyperaldosteronism treated with glucocorticoids
    • Reduced Renin, Reduced Aldosterone:• Liddle’s syndrome • Congenital Enzyme deficiency • Consumption of Licorice
  • Urine analysis with Urine pH and Urine chloride and sodium: low urine chloride(• GI loss: Emesis, Nasogastric tube suction • Lower Gastrointestinal etiology: Villous adenoma, chloridorrhea, excessive purgative use), high urine Cl (• Penicillin • Dysfunctional tubular transport: Loop Diuretics and thiazide diuretics, Bartter’s and Gitelman’s disease, Hypomagnesaemia)

• Some patients with Metabolic alkalosis may have severely reduced GFR with azotemia, which is usually suggestive of renal failure.

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