Generating factors

When metabolic alkalosis has developed, the initial treatment, whenever possible, is the correction of the underlying disease and elimination of the generating factors. Suppression of further bicarbonate generation or reabsorption may include the use of H 2 receptor antagonists or proton pump inhibitors in gastric alkalosis, the use of prostaglandin synthetase inhibitors or angiotensin-converting enzyme inhibitors in Bartter's syndrome, the use of antiemetic and antidiarrheic drugs in digestive losses, reduction or discontinuation of diuretic therapy, etc. Treatment of the underlying disease and elimination of generating factors should always be followed by the identification and reversal of maintenance factors, which can maintain the alkalosis even when the generating factors have disappeared.

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