AI Article Synopsis
- The kidney has both non-adaptive mechanisms in the proximal nephron and adaptive processes in the distal nephron to protect against metabolic alkalosis, which is the most common acid-base disturbance in hospitalized patients.
- The condition arises from changes that lead to the production of new bicarbonate (HCO3-) and the kidneys' ability to reclaim filtered HCO3- more effectively.
- A thorough assessment of the patient's blood volume, physical examination, and urine electrolytes is crucial for diagnosis and management, as metabolic alkalosis can sometimes be serious and requires aggressive treatment.
Article Abstract
The kidney is poised to defend against development of metabolic alkalosis through non-adaptive mechanisms in the proximal nephron and adaptive processes in the distal nephron. Despite a prodigious capacity to excrete base, metabolic alkalosis is the most common acid-base disturbance in hospitalized patients. Development of this disorder requires pathophysiologic changes leading to generation of new HCO3- combined with an augmentation in the capacity of the kidney to reclaim filtered HCO3-. The initial approach to these patients is careful assessment of effective arterial blood volume focusing on the physical examination and urine electrolytes. Identifying the mechanisms by which the kidney's ability to correct alkalosis are perturbed provides an understanding of the clinical approach to differential diagnosis and appropriate treatment. While metabolic alkalosis is frequently not dangerous, in certain settings, metabolic alkalosis may contribute to mortality and should be aggressively managed.
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| http://dx.doi.org/10.1093/ndt/gfae195 | DOI Listing |
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