Metabolic Alkalosis

Overview

What is alkalosis?

Alkalosis occurs when your blood and body fluids contain an excess of bases or alkali. Your blood’s acid-base (alkali) balance is critical to your well-being. When the balance is off, even by a small amount, it can make you sick.

What is metabolic alkalosis?

In metabolic alkalosis there is excess of bicarbonate in the body fluids. It can occur in a variety of conditions.

It may be due to digestive issues, like repeated vomiting, that disrupt the blood’s acid-base balance. It can also be due to complications of conditions affecting the heart, liver and kidneys. In mild cases, you might not experience symptoms. Severe forms of metabolic alkalosis can affect kidney functioning.

Are there other types of alkalosis?

Yes. Respiratory alkalosis occurs when you are breathing too fast or too deeply causing your lungs to get rid of too much carbon dioxide. This causes the carbon dioxide levels in the blood to decrease and the blood then becomes alkaline.

How does metabolic alkalosis affect my body?

Metabolic alkalosis happens when stomach acid is decreased or certain electrolyte levels drop. These changes throw off the acid-base balance.

Symptoms and Causes

Who is at risk for metabolic alkalosis?

People who experience severe bouts of vomiting can get metabolic alkalosis. It’s also common in people who are critically ill or in the hospital for certain conditions. The risk is especially high if you are dehydrated or need your stomach pumped (gastric suctioning). You may need suctioning to rid your stomach of abnormal fluid or gas build-up, poison or a medication overdose.

What causes metabolic alkalosis?

Metabolic alkalosis may be caused by consuming excessive amount of certain medications or supplements such as:

  • Antacids, which often contain the chemical sodium bicarbonate.
  • Baking soda.
  • Diuretics or water pills.
  • Certain laxatives.
  • Steroids.

Other causes of metabolic alkalosis include medical conditions such as:

  • Cystic fibrosis.
  • Dehydration.
  • Electrolyte imbalances, which affect levels of sodium, chloride, potassium and other electrolytes.
  • High levels of the adrenal hormone aldosterone (hyperaldosteronism).
  • Low levels of chloride in the blood (hypochloremia).
  • Recurrent vomiting, which occurs with cyclic vomiting syndrome.

What are the symptoms of metabolic alkalosis?

Diagnosis and Tests

When should I see a healthcare provider?

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

How is metabolic alkalosis diagnosed?

Healthcare providers use a variety of tests that include:

Management and Treatment

Will I need treatment?

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

What therapies might I receive?

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.
  • Stopping the medications that caused the condition, for example high doses of diuretics.

Prevention

How can I prevent metabolic alkalosis from coming back?

One prevention method is addressing the underlying cause. This may involve modifying treatments for other medical conditions. If you are 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 to avoid ingesting too much sodium bicarbonate.

Outlook / Prognosis

How soon will I feel better?

You should start feeling better shortly after therapies restore the acid-base balance. IV treatments take time for your body to absorb. And you may need more than one dose. Many people feel better within a few hours or the next day.

What can I expect after metabolic alkalosis treatment?

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.

Living With

What’s life like after metabolic alkalosis?

After successful metabolic alkalosis treatment, your life will likely not be much different than it was before. You may wish to make small changes to lower your risk of future episodes.

These changes may include:

  • Decreasing the dose of or discontinuing steroids, laxatives, water pills or antacids. Talk with your healthcare provider first to make sure it is safe for you to do so. Do not take these medications if they have not been prescribed by your provider.
  • Staying hydrated, which includes drinking water throughout the day.
  • Taking a multivitamin or supplements to help maintain safe electrolyte levels if advised to do so by your health care provider.
  • Visiting your provider on a regular basis to closely monitor treatments for other conditions, including heart, liver and kidney disease.

Can unhealthy habits lead to metabolic alkalosis?

  • Certain behaviors put you at risk, including:
  • 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).

If you are struggling with these issues, talk to your healthcare provider. Even if it’s uncomfortable discussing these topics, know that your provider can help. They can help you stop these habits, so you are less likely to experience alkalosis.

A note from Cleveland Clinic

Metabolic alkalosis occurs when digestive issues disrupt the blood’s acid-base balance. It can also be due to conditions affecting the liver, kidneys or heart. Metabolic alkalosis is usually not life-threatening. It does not have lingering effects on your health once it is treated. But it’s important to seek medical care because it can lead to severe complications. Treatment with IV fluids helps many people make a full recovery. Addressing the cause can lower your risk of future episodes.

Last reviewed by a Cleveland Clinic medical professional on 05/10/2021.

References

  • Merk Manual (Consumer Version). Alkalosis. (https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/alkalosis) Accessed 5/10/21.
  • National Center for Biotechnology Information (NCBI) Stat Pearls. Alkalosis. (https://www.ncbi.nlm.nih.gov/books/NBK545269/) Accessed 5/10/21.
  • National Center for Biotechnology Information (NCBI) Stat Pearls. Physiology Metabolic Alkalosis. (https://www.ncbi.nlm.nih.gov/books/NBK482291/) Accessed 5/10/21.
  • American Journal of Kidney Diseases. Treatment of Severe Metabolic Alkalosis in a Patient With Congestive Heart Failure. (https://www.ajkd.org/article/S0272-6386(13%2900097-8/abstract) Accessed 5/10/21.

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