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

Urine [Cl-  ]

Urine [Cl-  ]

Urine [Cl-  ]

Urine -

End

End

End

GRA, glucocorticoid-remediable aldosteronism; HTN, hypertension; JGA, juxtaglomerular apparatus.

GRA, glucocorticoid-remediable aldosteronism; HTN, hypertension; JGA, juxtaglomerular apparatus.

GRA, glucocorticoid-remediable aldosteronism; HTN, hypertension; JGA, juxtaglomerular apparatus.

<20 meq/L

<20 meq/L

<20 meq/L

>20 meq/L

>20 meq/L

>20 meq/L

Chloride-unresponsive alkaloses

Chloride-unresponsive alkaloses

Chloride-unresponsive alkaloses

*  After diuretic therapy

*  After diuretic therapy

*  After diuretic therapy

*

Chloride-responsive alkaloses

Chloride-responsive alkaloses

Chloride-responsive alkaloses

Gastric fluid loss

Gastric fluid loss

Gastric fluid loss

Nonreabsorbable anion delivery

Nonreabsorbable anion delivery

Nonreabsorbable anion delivery

Diuretics* 

Diuretics* 

* * Diuretics[*]

Posthypercapnea

Posthypercapnea

Posthypercapnea

Villous adenoma

Villous adenoma

Villous adenoma

Congenital chloridorrhea

Congenital chloridorrhea

Congenital chloridorrhea

Laxative abuse
Severe K+  depletion

Laxative abuse
Severe K+  depletion

Laxative abuse
Severe K+  depletion


+

Urine K+ 

Urine K+ 

Urine K+ 

+

<30 meq/L

<30 meq/L

<30 meq/L

>30 meq/L

>30 meq/L

>30 meq/L

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

Low/normal

Low/normal

Low/normal

High

High

High

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

Plasma renin

Plasma renin

Plasma renin

High

High

High

Low

Low

Low

Cushing's syndrome

Cushing's syndrome

Cushing's syndrome

Plasma cortisol

Plasma cortisol

Plasma cortisol

Normal

Normal

Normal

High

High

High

Renovascular HTN
JGA tumor

Renovascular HTN
JGA tumor

Renovascular HTN
JGA tumor


Malignant or accelerated HTN

Malignant or accelerated HTN

Malignant or accelerated HTN

High unilateral renal vein renin

High unilateral renal vein renin

High unilateral renal vein renin

Yes

Yes

Yes

No

No

No