Metabolic alkalosis: pathogenesis and physiopathology

Metabolic alkalosis is an acid-base disorder frequently encountered in hospitalised patients, particularly those in critical conditions and is not infrequently complicated by mixed acid-base disorders. This disorder can have serious clinical consequences, especially on the cardiovascular and central nervous systems. The disorder’s gravity is partly due to the precarious nature of the defence and compensation processes the body is able to provide to combat the alteration in the blood’s pH. Metabolic alkalosis is just one, secondary component of a complex water and electrolyte balance disorder, on which the maintenance of the acid-base disorder depends. Metabolic alkalosis can be a complication of various somewhat diverse conditions and is often common in hospital settings. A multitude of pathophysiological factors contribute to maintaining the acid-base disorder: these factors influence and feed one another. As the resolution of the acid-base disorder depends on the correction of these factors, it is essential to know their exact mechanisms in order to undertake the most appropriate therapeutic action.