Abstract：
Metabolic alkalosis is an uncommon clinical entity resulting from a wide variety of underlying etiologies including gastrointestinal, renal, endocrine, and metabolic causes. It is a typically clinically silent condition; however, severe cases can be life-threatening, mandating both a systematic investigative approach and an early aggressive management strategy.
We present a case of a 58-year-old man with severe, multifactorial metabolic alkalosis (pH 7.72, HCO3- 42 mmol/L, pCO2 31 mm Hg) resulting from refractory vomiting, severe hypokalemia (2.0 mmol/L), and hypoalbuminemia (albumin 20 g/L). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Severe metabolic alkalosis is associated with significant morbidity and mortality. Clinicians need to be aware of the potential underlying causes in these cases, as well as how to delineate between chloride- and non-chloride-depleted states, which dictates initial treatment. We provide a pragmatic summary of the evaluation, pertinent investigations, and early management of these cases.
We present a case of a 58-year-old man with severe, multifactorial metabolic alkalosis (pH 7.72, HCO3- 42 mmol/L, pCO2 31 mm Hg) resulting from refractory vomiting, severe hypokalemia (2.0 mmol/L), and hypoalbuminemia (albumin 20 g/L). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Severe metabolic alkalosis is associated with significant morbidity and mortality. Clinicians need to be aware of the potential underlying causes in these cases, as well as how to delineate between chloride- and non-chloride-depleted states, which dictates initial treatment. We provide a pragmatic summary of the evaluation, pertinent investigations, and early management of these cases.
摘要：
背景：代谢性碱中毒是一种罕见的临床实体，由多种潜在病因引起，包括胃肠道，肾,内分泌，和代谢原因。这是一种典型的临床症状；然而，严重的病例可能危及生命,强制采取系统的调查方法和早期积极的管理策略。
方法：我们介绍了一个58岁的男性，多因素代谢性碱中毒（pH7.72，HCO3-42mmol/L，pCO231mmHg）由难治性呕吐引起，严重低钾血症（2.0mmol/L），和低白蛋白血症（白蛋白20g/L）。为什么急诊医生应该意识到这一点？：严重的代谢性碱中毒与显著的发病率和死亡率相关。临床医生需要意识到这些病例的潜在根本原因，以及如何区分氯化物和非氯化物贫化状态，这决定了最初的治疗。我们提供了务实的评估总结，相关调查,以及这些案件的早期处理。
方法：我们介绍了一个58岁的男性，多因素代谢性碱中毒（pH7.72，HCO3-42mmol/L，pCO231mmHg）由难治性呕吐引起，严重低钾血症（2.0mmol/L），和低白蛋白血症（白蛋白20g/L）。为什么急诊医生应该意识到这一点？：严重的代谢性碱中毒与显著的发病率和死亡率相关。临床医生需要意识到这些病例的潜在根本原因，以及如何区分氯化物和非氯化物贫化状态，这决定了最初的治疗。我们提供了务实的评估总结，相关调查,以及这些案件的早期处理。
