Figure 632

Changes in plasma anionic pattern and body electrolyte balance during development, maintenance, and correction of metabolic alkalosis induced by vomiting. Loss of hydrochloric acid from the stomach as a result of vomiting (or gastric drainage) generates the hypochloremic hyperbicarbonatemia characteristic of this disorder. During the generation phase, renal sodium and potassium excretion increases, yielding the deficits depicted here. Renal potassium losses continue in the early days of the maintenance phase. Subsequently, and as long as the low-chloride diet is continued, a new steady state is achieved in which plasma bicarbonate concentration ([HCO3]) stabilizes at an elevated level, and renal excretion of electrolytes matches intake. Addition of sodium chloride (NaCl) and potassium chloride (KCl) in the correction phase repairs the electrolyte deficits incurred and normalizes the plasma bicarbonate and chloride concentration ([Cl-]) levels [22,23].


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