doyoudig
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one of the causes of chloride sensetive metabolic alkalosis is thiazide and loop diurtics,as i understand ,it happenes because diurtics leads to contraction of ECF and this leads to increased acid loss in distal tubules of kidneys because of stimulation of renin angiotensine aldosterone system,
but what i canot understand is why the urinary chloride will be less than 20meq/l,because diurtics ehance urinary excreation of Na and Cl,so why its level will be low?!!!
you reply will be really appreciated
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| Shaina
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urine cl shd be low in vomiting,
raised in barter
thats it i know,i guess not related with diuretics
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| dr in trouble
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urine cholride is increased in both barter synd and diuretic abuse.
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| doyoudig
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hey guys pls read the question again, Kaplan books and UW say diuretic such as thiazide/loops are Cl Sensitive metabolic alkalosis (ie Urinary Cl < 20)
why is the urinary chloride less than 20meq/l,because diurtics ehance urinary excreation of Na and Cl,so why its level will be low?????
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| ssrpk
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what exactly is the difference between chloride sensitive and resistant metabolic alkalosis??
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| doyoudig
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all I know is that Cl sensitive mean when u give NaCl the kideny responds properly by conserving Cl hence the loss must be d/t GI, or Diuretics and urinary Cl is < 20
vs in Cl restistant when you give NaCl the Kideny does not respond and Cl end up in the Urine, hence cause could be Barters, Mineralocorticoid deficiency, I guess urinary Cl is >
b/c of loss of cl into the urine
pls corrrect me if wrong, I am still unsure about each causes depending on low or high urinary Cl levels
but how does this worl with Diuretics, as they incr NaCl loss, i am confused about this part???
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| ssrpk
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hmmmmm, maybe its because of the fact that long term use of diuretics will cause body depletion of Cl- to such an extent that won't be much remaining to be excreted in he urine...
i tried to search this topic in harrison's, but didn't find any reasonable explanation.
however UW gives a more practical approach towards a patient with hypokalemic alkalosis with normotension, which states that if urinary chloride is low its surreptitious vomiting and if its high its either diuretics or barter's syndrome/gitelman's syndorme
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