Hypochlorite alkalosis

Introduction to low chloride alkalosis Hypochlorine alkalosis is a type of metabolic alkalosis that is more common in pediatric intensive care units. Metabolic alkalosis is a major hazard to the body. In addition to causing acid-base balance and electrolyte imbalance, severe cases can be life-threatening. Because it occurs in critically ill children and is based on other diseases (such as respiratory system, digestive system, nervous system, etc.), it is often covered by the primary disease, and the clinical manifestations are diversified and lack specificity. It is easily overlooked, and often the condition is delayed or aggravated by the inability to diagnose and treat it in time. basic knowledge The proportion of illness: 0.001% Susceptible people: more often in critically ill children Mode of infection: non-infectious Complications: hypokalemia

Causes of hypochlorine alkalosis

Chloride deficiency: Since Cl- is the only anion in the renal tubule that is easily reabsorbed with Na+, when the [Cl-] in the original urine is reduced, the renal tubules strengthen the discharge of H+ and K+ in exchange for the weight of Na+, HCO3- The absorption increases to produce NaHCO3. Therefore, due to the loss of H+, K+ and the increase in NaHCO3 reabsorption due to loss of hypochloremia, it can lead to metabolic alkalosis. At this time, the patient's urine Cl- is reduced. In addition, the aforementioned furosemide and diuretic acid can inhibit the active reabsorption of Cl- in the thick segment of the medullary ascending branch, thereby causing the lack of Cl-. At this time, the distal curved tube strengthens the rows H+ and K+ to exchange for too much Na+ reaching the distal curved tube. Therefore, it can also cause metabolic alkalosis. At this time, the patient's urine Cl- is elevated. Loss of HCl by vomiting means loss of Cl-, decrease of Cl- in plasma and urine, and metabolic alkalosis occurs through the above-mentioned Cl-reduction mechanism in the original urine.

In the case of alkalosis, the body will pass: 1. extracellular fluid buffer; 2. ion exchange; 3. respiratory compensation; 4. renal compensation and other compensation adjustment. Compensatory metabolic alkalosis is achieved by compensatory regulation such that the ratio of HCO3-/H2CO3 can be kept within the normal range; otherwise, it is called decompensated metabolic alkalosis.

Low chloride alkalosis prevention

1. If you find that you are abusing diuretics, stop using it immediately.

2. Patients with severe liver disease are prohibited from using ammonium chloride, lysine hydrochloride or arginine hydrochloride.

3. Actively prevent and treat the primary disease causing metabolic alkalosis and eliminate the cause.

4, patients with severe alkalosis can be given a certain amount of acidic drugs, such as arginine, ammonium chloride and so on.

Low chloride alkalosis complications Complications hypokalemia

Alkaline poisoning causes cardiovascular and cerebrovascular contraction, and blood supply is reduced, further aggravating tissue hypoxia. May be associated with clinical manifestations of hypokalemia and water shortage. In severe cases, there may be hypocalcemia.

Symptoms of hypochlorine alkalosis Common symptoms Hand, foot, numbness, dehydration, drowsiness, hypokalemia

Clinical manifestations include dehydration, thirst and oliguria (following the diuretic period), numbness of the hands and feet during alkalosis, and sometimes quadriplegia with hypokalemia. Lighter patients have no obvious symptoms, and severe ones have shallow and slow breathing, or mental and neurological abnormalities such as lethargy, confusion or paralysis. May be associated with clinical manifestations of hypokalemia and water shortage. In severe cases, there may be hypocalcemia.

Examination of hypochlorine alkalosis

Routine blood biochemistry, blood gas analysis, etc. can confirm the diagnosis and understand its severity. At the time of decompensation, blood pH and HC03- were significantly increased, and PaC02 was normal. The blood pH of the compensated period can be basically normal, but HC03- and BE (base residual) have a certain degree of increase.

Diagnosis and identification of hypochlorine alkalosis

A preliminary diagnosis can be made based on the medical history. Blood gas analysis can confirm the diagnosis and understand its severity. At the time of decompensation, blood pH and HC03- were significantly increased, and PaC02 was normal. The blood pH of the compensated period can be basically normal, but HC03- and BE (base residual) have a certain degree of increase.

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