Metabolic Alkalosis

Metabolic alkalosis occurs when your blood is too alkaline (too basic) due to digestive or kidney issues. Alkaline is the opposite of acidic. Your blood’s acid-base balance is critical to your well-being. When the balance is off, even by a small amount, it can make you sick.

Things like excessive vomiting and taking diuretics can disrupt your blood’s acid-base balance. Severe forms of metabolic alkalosis can affect your kidney function. In mild cases, you might not have any symptoms.

Types of metabolic alkalosis

The two types are:

• Chloride-responsive alkalosis: This is when you lose too much acid. It happens from the loss of hydrogen ions, usually by vomiting or severe dehydration. Treatment with IV fluids containing saline solution or eating more salt can help with this type.
• Chloride-resistant alkalosis: This type usually happens from taking too much of certain medications or an underlying health condition. Eating more salt will not help this type. Instead, you’ll need to eat more potassium.

Symptoms of metabolic alkalosis

You may not have any symptoms of metabolic alkalosis. If you do, they could include:

• Diarrhea
• Vomiting
• Tingling or numbness
• Muscle cramping

Severe cases could cause symptoms like:

• Confusion or disorientation
• Agitation
• Seizures

How does your body compensate for metabolic alkalosis?

Your body tries to compensate for metabolic alkalosis. Your lungs and kidneys respond to try to counteract the effects of the condition:

• Lungs: Your breathing slows down. This changes the concentration of bicarbonate ions in your blood.
• Kidneys: Your kidneys release bicarbonate ions through your pee to try to get rid of them.

Metabolic alkalosis causes

Metabolic alkalosis causes your body’s pH level to rise above a typical range. This happens because you have too much bicarbonate and not enough hydrogen in your blood. Bicarbonate is a compound that helps maintain pH levels and balance electrolyte levels.

Things that disrupt this balance and lead to metabolic acidosis are:

• Losing stomach acid: Recurrent vomiting or getting your stomach pumped can cause you to lose stomach acid. Loss of acid in your body means an increase in the alkalinity of your blood.
• Taking too many antacids: Antacids containing sodium bicarbonate can cause metabolic alkalosis in people with kidney failure.
• Using diuretics or water pills: Taking this medication too often can make your body release too much acid in your pee. This makes your blood more alkaline.
• Taking laxatives: Laxatives cause excessive diarrhea. You lose important electrolytes like potassium and chloride through your poop.
• Dehydration: You lose key electrolytes when you have dehydration. This increases your blood’s alkalinity.

Other causes of metabolic alkalosis include conditions like:

• Genetic conditions that cause your kidneys to release excess electrolytes
• High levels of the adrenal hormone aldosterone (hyperaldosteronism)
• Low levels of chloride in your blood
• Potassium deficiency (hypokalemia)
• Heart, kidney or liver failure

Risk factors

Certain factors put you at risk, including:

• Needing to get your stomach pumped
• Alcohol consumption to the point of vomiting
• Taking laxatives to lose weight
• Taking diuretics to reduce swelling or lose weight
• Making yourself throw up after eating (bulimia nervosa)
• Having hyperemesis gravidarum during pregnancy

Complications of metabolic alkalosis

While the condition is manageable, it can lead to complications. Some of the most common are:

• Abnormal heart rhythm (arrhythmia) or heart failure
• Reduced breathing rate or stopping breathing altogether
• Kidney damage due to severe electrolyte imbalance
• Coma

How doctors diagnose metabolic alkalosis

Healthcare providers use a variety of tests that include:

• Physical exam to check your symptoms
• Blood tests to measure blood gases, acid-base balance and electrolyte levels
• Electrocardiogram (EKG) to check for an arrhythmia
• Urinalysis, which may help find the cause of the metabolic alkalosis

What is the treatment for metabolic alkalosis?

Your care depends on the cause and severity of your symptoms. Mild cases might not require treatment. Severe symptoms need immediate attention.

Metabolic alkalosis treatment uses an intravenous (IV) line to deliver fluid and other substances, such as:

• Saline infusion
• Potassium replacement
• Magnesium replacement
• Chloride infusion
• Hydrochloric acid infusion

If excessive use of medications is the cause, stopping those medications is another possible treatment. Only do this if your provider tells you to.

Recovery time

Most people feel better and resume their everyday lives after completing treatment. But it can come back if low stomach acid, fluid or electrolyte levels affect the acid-base balance.

When should I see a healthcare provider?

Many metabolic alkalosis symptoms are concerning and need prompt medical evaluation. If you’re experiencing an arrhythmia, seizures or confusion, seek care right away.

What can I expect if I have metabolic alkalosis?

After treatment, your life will likely not be much different than it was before. Your healthcare provider may recommend ways to lower your risk of future episodes. This could include:

• Decreasing the dose or discontinuing the use of antacids, laxatives or diuretics
• Drinking lots of water throughout the day to keep hydrated
• Taking a multivitamin or supplements to help maintain safe electrolyte levels

Another prevention method is to address the underlying cause. This may involve modifying treatments for other medical conditions. If you’re taking water pills to reduce strain on your heart, healthcare providers may reduce the dose. People who take antacids for GERD may need a different medication. Your provider will work with you to help treat the underlying cause.