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Principles of Heart Failure Pharmacotherapy
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Erika L. Hellenbart, Stephanie Dwyer Kaluzna, Robert J. DiDomenico
Because sequential nephron blockade can induce a robust diuresis, the most common adverse effects relate to fluid shifts. Electrolyte deficiencies, particularly hypokalemia and hypomagnesemia, are common despite repletion.48,72 Although less common, hyponatremia is also possible if sodium excretion exceeds water excretion. Patients may also develop a hypochloremic metabolic alkalosis (e.g., contraction alkalosis). The robust diuresis can also result in hypotension and WRF, the latter leading to prolonged durations of action of the thiazide-like diuretics.72 Consequently, patients treated with sequential nephron blockade require close monitoring of net urine output, hemodynamics, and frequent (e.g., once or twice daily) monitoring of electrolytes and renal function.48,72
Acid–base disturbances
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
The administration or endogenous production of alkali will result in metabolic alkalosis, as will hypoalbuminaemia, since albumin is a weak acid. Because plasma is normally slightly alkaline by comparison with pure water, a deficit of free water results in a metabolic alkalosis, as the plasma is literally more concentrated. This is known as contraction alkalosis.
Complications in Pediatric Surgery
Published in Stephen M. Cohn, Matthew O. Dolich, Complications in Surgery and Trauma, 2014
Shannon W. Longshore, Gerald Gollin
Pyloric stenosis does not require an emergency operation. Adequate fluid and electrolyte resuscitation should occur prior to an operation. Many of these patients have been vomiting for days, if not weeks, and will present with a hypochloremic, hypokalemic, metabolic alkalosis. If left untreated, this contraction alkalosis will pre-dispose to perioperative apnea or respiratory arrest.
The patient with metabolic alkalosis
Published in Acta Clinica Belgica, 2019
Valentine Gillion, Michel Jadoul, Olivier Devuyst, Jean-Michel Pochet
Experimental studies have clearly shown that metabolic alkalosis may persist even if its cause is corrected [27]. Maintenance of metabolic alkalosis generated by chloride depletion was classically attributed to volume contraction (e.g. dehydration) but some studies in rats and humans suggested another mechanism. Indeed, Cl- repletion corrects metabolic alkalosis even when volume contraction is maintained [20]. Given the existence of a distal Cl-HCO3 exchange (Figure 1), the pivotal role of Cl- depletion in the maintenance of metabolic alkalosis is best explained by a shortage of Cl- in the collecting duct. Indeed, reabsorption of Cl- is almost complete upstream in the nephron in case of Cl- depletion leaving no Cl- to be reabsorbed in exchange with bicarbonate. The term chloride depletion alkalosis should then replace the concept of contraction alkalosis.
Acid–base and me
Published in Medical Teacher, 2019
What flaw had he found? Contraction alkalosis is shorthand for a common acid–base disturbance that every physician will encounter in their career. While the phenomenon was well known in 1987, when Pete posed his question, the underlying mechanism would not be solved until years later. Nonetheless, textbooks at the time provided a simple explanation, which I taught and which he saw through.