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  • • Elevated serum pH (> 7.45)

    • Increased serum HCO3

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Epidemiology

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  • • Most common acid-base disturbance in surgical patients

    • Pathogenesis involves loss of H+ via NG suction, volume depletion, and hypokalemia

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Laboratory Findings

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  • • Elevated serum pH

    • Increased serum HCO3

    • Paradoxical aciduria

    • Hypokalemia

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  • • May be mixed, most commonly with respiratory acidosis, but ventilatory compensation is limited

    • Usually marked volume depletion

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  • • Serum electrolytes

    • ABG measurement

    • Urine electrolytes

    • Urine pH

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  • • Fluid resuscitation (usually with normal saline)

    • Potassium repletion as KCl

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Treatment Monitoring

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  • • Serial ABG measurement

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Prognosis

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  • • Excellent

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Prevention

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  • • Maintain euvolemia

    • Potassium supplementation

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References

Adrogue HJ et al. Management of life-threatening acid-base disorders. (Two parts.) N Engl J Med. 1998;338:26, 107.

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