علاج القلاء الاستقلابي مع ارتفاع ضغط الدم ونقص بوتاسيوم الدم وحالات القشرانيات المعدنية المرتفعة

References

• The treatment of metabolic alkalosis with volume expansion (urine Cl− > 20 mmol/L and elevated blood pressure) is mainly directed at modification of the primary cause when associated with high mineralocorticoid states, and the correction of hypokalemia.
• Almost all cases of Cl−-resistant alkalosis are associated with hypokalemia; therefore, the correction of K+ deficiency is essential to diminish the severity of metabolic alkalosis.
• Removing the source of mineralocorticoid excess, as in adrenal or pituitary tumors, is the cornerstone of this therapy.
• In other cases, such as in primary hyperaldosteronism, treatment could be pursued via direct hormone blockade with the use of mineralocorticoid receptor antagonists (eg, spironolactone, eplerenone) or via amiloride, an ENaC blocker.
• The judicious use of oral or intravenous K+ supplementation is advised, depending on the severity of the hypokalemia.