Lim
Forum Elite
Topics: 62
Posts: 210
|
in metabolic alkalosis, what does chloride responsive and resistent mean?
'chloride responsive' means kidney has normal function and it works well? reason of metbolic alkalosis is not kidney?
*Chloride-responsive type
1.Gastric fluid loss (eg, vomiting, NG drainage)
2.Volume contraction (eg, secondary to loop or thiazide diuretics)
3.Congenital chloride diarrhea
4.Posthypercapnia syndrome (especially in mechanically ventilated patients with chronic lung disease)
5.Cystic fibrosis (in toddlers)
*Chloride-resistant type
1.Primary aldosteronism
2.Bartter syndrome (renal sodium, potassium, and chloride wasting; often presents as failure to thrive)
3.DOC excess syndrome (congenital adrenal hyperplasia variant)
4.Liddle syndrome (autosomal dominant; unregulated sodium resorption in renal collecting duct) 5.Excessive ingestion of licorice
6.Chronic potassium depletion (eg, anorexia nervosa)
7.Primary reninism
8.Hyperglucocorticoidism
9.Milk-alkali syndrome (excess calcium plus bicarbonate intake and vomiting)
thanks in advance.
___________________
The secret is never give up
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
from what I understand is that in chloride responsive problems, if the Pt is given NaCl the kidney will function appropriately and conserve the chloride, hence ur urine cl levels will be low
whereas in chlordie reistant proble, giving NaCl does not correct the problem and chloride ends up in urine hence > urine chloride levels.
pls somone correct if wrong....
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
Metabolic Alkalosis [left]A condition characterized by a primary increase in extracellular fluid bicarbonate; pH and carbon dioxide content are increased.[/left] [left]Metabolic alkalosis results from net acid loss or alkali gain in the extracellular fluid. Acid loss can result from vomiting, prolonged gastric suctioning, and diuretic use. The concomitant chloride deficiency requires that the high bicarbonate be reabsorbed with sodium and will not correct until adequate chloride ion is available (ie, treated with sodium chloride, potassium chloride, or hydrochloride). The chloride-resistant forms of metabolic alkalosis common in the elderly include an excessive mineralocorticoid effect of chronic prednisone administration, renin-angiotensin-aldosterone stimulation due to renal atherosclerosis, Cushing's disease, primary aldosteronism, and ectopic corticotropin (ACTH) production due to malignancy. In these cases, the mineralocorticoid excess dictates excessive renal generation of bicarbonate because of stimulated sodium/hydrogen exchange. Treatment is directed toward mineralocorticoid antagonism.[/left] [left]Lethargy and stupor may occur from adverse effects on the cerebral circulation. Arrhythmias, especially due to digitalis toxicity, are common. Therapy depends on whether the metabolic alkalosis is sensitive or resistant to chloride. The chloride-sensitive forms respond to administration of chloride, such as in normal saline. Gastric acid and chloride losses can be reduced by giving a histamine-2 blocker or a proton pump inhibitor. Bicarbonate diuresis can also be accomplished using carbonic anhydrase inhibition; acetazolamide 250 mg IV can be given bid or qid in severe cases or when patients are unable to take drugs orally. Chloride-resistant forms require treatment of the underlying disorder or mineralocorticoid antagonism with spironolactone. A dose of 50 to 100 mg/day po in divided doses may help patients with chronic alkalosis[/left]
|
| doyoudig
Forum Guru
Topics: 144
Posts: 613
|
Chloride-responsive metabolic alkalosis involves urine chloride levels of less than 10 mEq/L and is characterized by decreased ECF volume and low serum chloride levels, such as occurs with vomiting. This type responds to administration of chloride salt. Chloride-resistant metabolic alkalosis involves urine chloride levels of more than 20 mEq/L and is characterized by increased ECF volume. As the name implies, this type resists administration of chloride salt. Primary aldosteronism is an example of chloride-resistant metabolic alkalosis
|
| dudefop
Forum Newbie
Topics: 5
Posts: 22
|
1.
In chloride(saline) responsive metabolic alkalosis, you initally loose both your acid and volume (eg. vomiting)
-->
Loosing acid makes it "alkalosis".
Loosing your volume will activate your normal kidney to reabsorb NaCl and water in an effort to preserve your volume.
-->
Therefore urinary Cl will be low (<10~20 mEq/L)
What about Na?
-->
Well, in alkalosis, HCO3- is excreted more than usual and HCO3- in the urine picks Na+ as the accompanying cation, excreting it even if volume depletion is present.
-->
Therefore, urinary Cl– is preferred to urinary Na+ as a measure of extracellular volume
in metabolic alkalosis.
So the basic concept is that acid loss and volume depletion makes saline responsive metabolic alkalosis hence if you hydrate the patient with saline the metabolic alkalosis will be cured.
___________________
Passed step1, Step2 CS. Now preparing for CK. Grad of Inha Univ. College of Medicine, South Korea.
|
|
| |
| | | | | |
