VBG → ΔHCO3:ΔPCO2 = 1:0.7 → respiratory compensation

Often associated with Hypokalemia - ↓K (<3.5)

DDx

1. ECFVD - Volume depletion → contraction alkalosis

2) Emesis(vomiting)

• Cause stomach to excessively produce HCl → Bicarbs are produced as byproducts

  

3) Hyper-aldosteronism

• Aldosterone , Hyperaldosteronism ↑ → RAA activation

• Increased H+ ATPase activity in Ammoniagenesis → more HCO3 production

  

4) Hypokalemia - ↓K (<3.5)

• Increase in HCO3 - Bicarbs causes intracellular shift of K Potassium (3.5-5) → Hypokalemia - ↓K (<3.5)
• Renal tubule: low K → retain more K → excrete more Na → more ECFVD - Volume depletion → more [HCO3] → more more Na excretion

5) In-hospital causes

• Surgical → NG Tube Drain
• Medical → Diuretics (in the context of HF - Heart Failure)

Managemenbt

• KCl - potassium chloride bolus (5-10mEq/h) will allow kidneys to sort out;
• 2nd line: ammonium chloride or 0.1N HCl needed.