What is this Condition?

Metabolic alkalosis is an acid-base imbalance in the body fluids caused by too little acid or too much of a base compound called bicarbonate. Metabolic acidosis is always brought on by some other illness. This imbalance causes metabolic, respiratory, and kidney effects and, especially, depressed breathing.

With early diagnosis and prompt treatment, the chance of correcting this chemical imbalance is good. However, untreated metabolic alkalosis may lead to coma and death.

What Causes it?

Metabolic alkalosis is caused by loss of acid compounds or retention of base compounds in body fluids due to various disorders or drug actions. The body fluids become more alkaline than acid.

Acid Loss

Causes of critical acid loss include vomiting, excessive suctioning of the stomach with a tube, abnormal openings in the stomach (such as perforation caused by ulcers), and the use of certain drugs, including corticosteroids and diuretics. Diseases that cause acid loss include hyperadrenocorticism, Cushing’s disease, hyperaldosteronism, and Bartter’s syndrome.

Base Retention

Causes of base retention include excessive intake of bicarbonate of soda or other antacids (usually for treatment of gastritis or peptic ulcer), toO much alkali (as in milk-alkali syndrome with peptic ulcers), or too much intravenous fluid containing bicarbonate.

What are its Symptoms?

Symptoms begin when the person’s body tries to correct the acid-base imbalance, primarily through hypoventilation, which causes slow, shallow respirations. The person also may feel irritable, pick at his bedclothes, twitch, act confused, and complain of nausea, vomiting, and diarrhea. Because the heart, circulation, and breathing are all disturbed, the person with uncorrected alkalosis may have seizures and fall into a coma.

How is it Diagnosed?

Because the person is often in the hospital for another disorder, the doctor can observe his or her symptoms and then confirm metabolic alkalosis with blood tests and urine tests. The most important test for detecting metabolic alkalosis is called arterial blood gas analysis. The doctor may also use an electrocardiogram to determine the effects of this imbalance on the heart’s function.

How is it Treated?

The doctor tries to correct the underlying cause of metabolic alkalosis - for example, by discontinuing the use of drugs such as diuretics or stopping stomach suctioning. Fluids and elements such as potassium may need to be replaced. For the person with severe alkalosis, the doctor may prescribe intravenous ammonium chloride or other solutions to restore the person’s chemical balance.

What do Doctors call these Conditions?Hypocalcemia, hypercalcemia

What are these Conditions?

Calcium imbalance results tram too much or too little calcium in the blood. Too little calcium is called hypocalcemia; too much calcium, hypercalcemia. Altered calcium levels may interfere with how the body’s cells do their job as well as the formation of bones and teeth, blood clot­ting, transmission of nerve impulses, and normal muscle contraction.

Nearly all (99%) of the body’s calcium is found in the bones; the remaining 1 % exists in the blood. The body’s nervous system relies on this blood-borne calcium supply to function properly. The parathyroid glands (four small glands located in the neck) regulate blood calcium by controlling how much of it is taken up by bone, absorbed from the digestive system, and excreted in urine and feces.

What Causes Calcium Deficiency?

Causes of low calcium levels include:

• too little parathyroid hormone secretion, caused by injury, disease, or surgery

• poor absorption or loss of calcium from the digestive tract, caused by severe diarrhea or laxative abuse - or, sometimes, from lack of vitamin D or parathyroid hormone, or too little acid in the stomach

• consuming too little calcium and vitamin D

• severe infections or burns

• overcorrection of another imbalance called acidosis

• a poorly functioning pancreas

• kidney failure

• too little magnesium.

What Causes Calcium Excess?

Causes of excessive calcium include the following:

• overactive parathyroid glands

• too much vitamin D

• tumors that put calcium into the blood

• multiple fractures and prolonged inactivity

• bone cancers.

What are the Symptoms of Calcium Deficiency?

Because too little calcium causes irritated nerves and muscle spasms, the person may feel a tingling around the mouth, twitching, wrist spasm, seizures and, possibly, irregular heartbeats.

When examining a person, a doctor or nurse will look for two reliable signs of calcium deficit:

• Chvostek’s sign - a tap on the facial nerve by the earlobe that causes the person’s upper lip to twitch

• Trousseau’s sign - a blood pressure cuff applied around the arm and inflated, causing the person’s thumb and fingers to twitch.

What are the Symptoms of Calcium Excess?

The person may develop weakness, decreased muscle tone, lethargy, loss of appetite, constipation, nausea, vomiting, dehydration, extreme thirst, and frequent urination. A severe condition may lead to irregular heartbeats and, eventually, coma.

How are they Diagnosed?

The doctor will order blood tests and urine tests to measure calcium levels and determine if symptoms are related to a calcium imbalance. The doctor will perform an electrocardiogram to determine the effects of the imbalance on the person’s heart.

How is Calcium Deficiency Treated?

If calcium deficiency is mild, treatment may simply be a change in diet. The doctor may suggest a diet that includes more calcium, vitamin 0 (found in most multivitamins), and protein, possibly with oral calcium supplements.

If calcium deficiency is severe, the doctor may prescribe intravenous administration of calcium gluconate or calcium chloride. A chronic problem also requires vitamin 0 supplements to induce the digestive system to absorb the calcium.

How is Calcium Excess Treated?

Treatment primarily involves getting rid of the excess calcium by giving intravenous fluids, which promote calcium excretion in urine. The doctor may also prescribe diuretics to aid excretion of calcium and other drugs if there are complications, such as excessive vitamin o or certain tumors.