Metabolic alkalosis

• A supranormal arterial blood pH with a base excess >2 mmol/l caused either by loss of (non-carbonic) acid or gain of base. As the kidney is usually efficient at excreting large quantities of bicarbonate, persistence of a metabolic alkalosis usually depends on either chronic renal failure or a diminished extracellular fluid volume with severe depletion of K+.

• The patient is usually asymptomatic though, if spontaneously breathing, will hypoventilate.

• A metabolic alkalosis will cause a left shift of the oxyhaemoglobin curve, reducing oxygen availability to the tissues.

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