Metabolic alkalosis

• Assess the patient's blood pressure and volume status.

• Evaluate for exogenous ingestion (e.g., laxatives, calcium, alkali load, diuretics).

• Obtain BMP and serum calcium, urinary chloride, and urinary potassium levels.

  • Low urine chloride (< 25 mEq/L): chloride-responsive metabolic alkalosis

  • High urine chloride (> 40 mEq/L): chloride-resistant metabolic alkalosis ; check urine potassium.

    • High urine potassium (> 30 mEq/L): Review blood pressure.

      • Elevated blood pressure: Consider mineralocorticoid excess as a potential cause.

      • Low or normal blood pressure: Consider Gitelman syndrome or Bartter syndrome as a potential cause.

    • Low urine potassium (< 20 mEq/L): Consider laxative abuse as a potential cause.

Elevated calcium with renal failure suggests milk-alkali syndrome.