Alkali administration

Isolated alkali ingestion or administration only causes persistent metabolic alkalosis when the absorption is massive and prolonged. Much more commonly, metabolic alkalosis occurs after alkali administration in patients who present or develop oliguric renal failure. Typical situations in critically ill patients are abundant transfusions of citrated blood for hemorrhagic shock, or sodium bicarbonate therapy for metabolic acidosis due to circulatory arrest. Considerable alkalosis may develop when the excess lactate is metabolized and bicarbonate cannot be eliminated. In patients with renal failure, metabolic alkalosis can also result from the administration of lactate in the hemofiltration replacement fluid.

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