The Diagnostic Approach to Metabolic Alkalosis - Flowchart
The Diagnostic Approach to Metabolic Alkalosis - Flowchart
«Flowchart»

Urine [Cl–]

Urine [Cl–]

Urine [Cl–]

Urine –

<20 meg/L

<20 meg/L

<20 meg/L

>20 meg/L

>20 meg/L

>20 meg/L

Chloride-unresponsive alkaloses

Chloride-unresponsive alkaloses

Chloride-unresponsive alkaloses

Laxative abuse
Severe K+ depletion

Laxative abuse
Severe K+ depletion

Laxative abuse
Severe K+ depletion


+

Bartter's or Gitelman's syndrome, or diuretic abuse

Bartter's or Gitelman's syndrome, or diuretic abuse

Bartter's or Gitelman's syndrome, or diuretic abuse

Primary aldosteronism, bilateral adrenal hyperplasia, Liddle's syndrome, GRA, licorice

Primary aldosteronism, bilateral adrenal hyperplasia, Liddle's syndrome, GRA, licorice

Primary aldosteronism, bilateral adrenal hyperplasia, Liddle's syndrome, GRA, licorice

Cushing's syndrome

Cushing's syndrome

Cushing's syndrome

Renovascular HTN JGA tumor

Renovascular HTN JGA tumor

Renovascular HTN JGA tumor

Malignant or accelerated HTN

Malignant or accelerated HTN

Malignant or accelerated HTN

* After diuretic therapy

* After diuretic therapy

* After diuretic therapy

*

End

End

End

Chloride-responsive alkaloses

Chloride-responsive alkaloses

Chloride-responsive alkaloses

Congenital chloridorrhea

Congenital chloridorrhea

Congenital

Villous adenoma

Villous adenoma

Villous

Posthypercapnea

Posthypercapnea

Posthypercapnea

Diuretics*

Diuretics*

* * Diuretics

Nonreabsorbable anion delivery

Nonreabsorbable anion delivery

Nonreabsorbable

Gastric fluid loss

Gastric fluid loss

Gastric

Urine K+

Urine K+

Urine K+

+

<30 meg/L

<30 meg/L

<30 meg/L

>30 meg/L

>30 meg/L

>30 meg/L

Blood pressure

Blood pressure

Blood pressure

Low/normal

Low/normal

Low/normal

High

High

High

Plasma renin

Plasma renin

Plasma renin

High

High

High

Low

Low

Low

Plasma cortisol

Plasma cortisol

Plasma cortisol

Normal

Normal

Normal

High

High

High

High unilateral renal vein renin

High unilateral renal vein renin

High unilateral renal vein renin

Yes

Yes

Yes

No

No

No