|
Differential diagnosis of a metabolic alkalosis (increased SID) |
| Chloride loss < sodium loss |
| Chloride responsive (urine Cl- concentration <10 mmol/l) |
| Gastrointestinal losses: vomiting, gastric drainage, chloride |
| wasting diarrhea (villous adenoma) |
| Postdiuretic use |
| Posthypercapnea |
| Chloride unresponsive (urine Cl- concentration >20 mmol/l) |
| Mineralocorticoid excess: primary hyperaldosteronism (Conn's |
| syndrome), secondary hyperaldosteronism, Cushing's |
| syndrome, Liddle's syndrome, Bartter's syndrome, |
| exogenous corticoids, excessive licorice intake |
| Ongoing diuretic use |
| Exogenous sodium load (>chloride) |
| Sodium salt administration (acetate, citrate): massive blood |
| transfusions, parenteral nutrition, plasma volume expanders, |
| sodium lactate (Ringer's solution) |
| Other |
| Severe deficiency of intracellular cations: Mg2+, K+ |
|
SID, strong ion difference. |
Kellum Critical Care 2000 4:6 doi:10.1186/cc644 |