Metabolic alkalosis treatment standard.

This article focuses on the pathophysiology, clinical assessment, and treatment of metabolic alkalosis, the most common acid–base disturbance in hospitalized patients. It explains that metabolic alkalosis arises from both generation of new bicarbonate (HCO3–) and enhanced renal reabsorption of filtered HCO3–, involving non-adaptive mechanisms in the proximal nephron and adaptive processes in the distal nephron, particularly via pendrin-mediated bicarbonate secretion. The article emphasizes the importance of assessing effective arterial blood volume and urinary electrolytes to guide diagnosis and treatment, which centers on correcting underlying causes such as volume depletion, mineralocorticoid excess, or diuretic use. While often benign, metabolic alkalosis can contribute to serious complications including cardiac and neurological dysfunction, warranting targeted and sometimes aggressive management.