Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (615 page)

   Glycogen deposition

   Chronic alkalosis

   Potassium-losing nephropathy

   Hypoproteinemia per se may cause a nonrespiratory alkalosis. Decreased albumin of 1 g/dL causes an average increase in standard bicarbonate of 3.4 mmol/L, an apparent base excess of +3.7 mmol/L, and a decrease in AG of approximately 3 mmol/L.

   Diagnostic Findings

   Serum pH is increased (>7.60 in severe alkalemia).

   Total plasma CO
₂
is increased (bicarbonate >30 mmol/L).

   pCO
₂
is normal or slightly increased.

   Serum pH and bicarbonate above those predicted by the pCO
₂
(by nomogram).

   Hypokalemia is an almost constant feature and is the chief danger in metabolic alkalosis.

   Decreased serum chloride is relatively lower than sodium.

   BUN may be increased.

   Urine pH is >7.0 (≤7.9) if potassium depletion is not severe and concomitant sodium deficiency (e.g., vomiting) is not present. With severe hypokalemia (<2.0 mmol/L), urine may be acid in presence of systemic alkalosis.