Alkalotics Anonymous

​A 50-year-old man with a past medical history of alcoholism presented to the ED with altered mental status, nausea, and vomiting. He is arousable but a poor historian. His girlfriend said he drinks a half-gallon of rum daily, and had his last drink two days earlier. She reported that he started to feel nauseous, vomit, and go through alcohol withdrawal. She said he also has been taking a lot of calcium carbonate for an upset stomach, but she was unable to say exactly how much. ​ His blood pressure was 146/70 mm Hg, heart rate was 110 bpm, respiratory rate was 14 bpm, PO2 was 96% on room air, and blood glucose was 167 mg/dL. Labs are remarkable for a significant metabolic alkalosis: ABG 7.65, pCO2 69, pO2 108, and HCO3 58. The chemistry is included below. The documented lactate was 9 mmol/L, and the ethanol level was negative. The patient's ECG demonstrated a prolonged QTc of 540.  The Five Toxicological Causes of Metabolic Alkalosis​Loop or thiazide diuretics are a common cause of metabolic alkalosis even in therapeutic doses: Metabolic alkalosis is caused by the depletion of chloride ions and the increased delivery of sodium ions to the collecting duct. This enhances potassium ion and hydrogen ion secretion, resulting in metabolic alkalosis.Ingesting sodium bicarbonate (baking soda) for self-treatment as a home remedy: Ingesting a moderate amount of bicarbonate leads directly to an increase in serum bicarbonate and thus an alkalosis.Exces...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

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