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How to treat metabolic alkalosis (USMLE STEP 1)

How to treat metabolic alkalosis (USMLE STEP 1)

– correction of underlying disorder

– correction of hypovolemia with chloride-containing solutions (0.9% NaCl)

– correction of hypokalemia (ensure adequate renal function first)

– provision of acid solutions in refractory cases

a) chloride deficit

weight (kg) X 0.4 X (100 – measured Cl)

b) calculate amount of 0.1 N HCl acid solution

– required to replace deficit

– replace slowly over 6-24 hours with frequent re-evaluations

– acetazolamide (diamox) (dosage 500 mg Q6H) inhibits carbonic anHydrase, preventing renal reclamation and synthesis of bicarbonate; loses effect as serum bicarbonate decreases

– for prolonged gastric suctioning, H2 antagonists may decrease gastric acid production and minimize acid loss.

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