Cause of Alkalemia

By SWA

Alkalemia refers to a condition where the blood has a higher than normal pH, indicating that it is more alkaline. The normal pH range for blood is 7.35 to 7.45. When the pH rises above 7.45, it is considered alkalemia. This condition can result from various causes, broadly categorized into metabolic and respiratory origins:

Metabolic Alkalemia:

Metabolic alkalemia occurs when there is an excess of bicarbonate (HCO3-) in the blood or a loss of hydrogen ions (H+). Key causes include:

  1. Loss of Gastric Acid: This can happen due to prolonged vomiting or nasogastric suction, leading to a significant loss of hydrochloric acid (HCl) from the stomach.

  2. Excessive Bicarbonate Intake: Overuse of bicarbonate-containing antacids or excessive intake of sodium bicarbonate can raise blood bicarbonate levels.

  3. Diuretic Use: Certain diuretics, particularly loop and thiazide diuretics, can cause the kidneys to excrete more hydrogen ions and potassium, leading to a rise in blood bicarbonate.

  4. Hypokalemia: Low potassium levels can cause a shift of hydrogen ions into cells, increasing blood pH.

  5. Hormonal Disorders: Conditions such as Cushing's syndrome or primary hyperaldosteronism can increase the reabsorption of bicarbonate and excretion of hydrogen ions in the kidneys.

Respiratory Alkalemia:

Respiratory alkalemia is caused by hyperventilation, which leads to a decrease in carbon dioxide (CO2) levels in the blood. Lower CO2 levels reduce the formation of carbonic acid, raising the blood pH. Causes include:

  1. Hyperventilation Syndrome: Often triggered by anxiety, pain, or panic attacks, causing rapid breathing.

  2. Hypoxia: Conditions like high altitude, severe anemia, or lung diseases (such as pulmonary embolism or pneumonia) can lead to increased breathing rate to compensate for low oxygen levels.

  3. Central Nervous System Disorders: Injuries, infections, or tumors affecting the brain's respiratory centers can cause hyperventilation.

  4. Drugs: Certain medications, such as salicylates (aspirin) in high doses, can stimulate the respiratory center and cause hyperventilation.

  5. Fever: Elevated body temperature can increase respiratory rate, leading to decreased CO2 levels.

    Causes of Metabolic Alkalemia

  6. Loss of Hydrogen Ions (H+):

    • Vomiting: One of the most common causes of metabolic alkalemia is the loss of gastric acid (hydrochloric acid, HCl) due to prolonged vomiting. The loss of HCl leads to a decrease in H+ ions, resulting in an increase in blood pH.
    • Gastric Suctioning: Similar to vomiting, gastric suctioning (nasogastric suction) can remove stomach acid, leading to alkalosis.
    • Diuretic Use: Certain diuretics (like loop and thiazide diuretics) increase the excretion of H+ ions and potassium (K+) through the kidneys. The loss of H+ ions contributes to alkalosis.

  7. Increase in Bicarbonate (HCO3-):

    • Excessive Bicarbonate Intake: Overconsumption of bicarbonate (e.g., antacids or sodium bicarbonate supplements) can directly increase blood bicarbonate levels, leading to alkalosis.
    • Contraction Alkalosis: When there is a significant loss of extracellular fluid (e.g., due to diuretics or severe dehydration), the concentration of bicarbonate in the remaining fluid increases, leading to alkalosis.

  8. Shifts in Electrolytes:

    • Hypokalemia (Low Potassium): Low levels of potassium can cause a shift of H+ ions into cells to maintain electrochemical balance, resulting in a decrease in H+ ions in the blood and thus metabolic alkalosis.
    • Renal Compensation: In response to various stimuli (e.g., aldosterone excess), the kidneys may excrete more H+ ions and reabsorb more bicarbonate, contributing to alkalosis.

  9. Endocrine Disorders:

    • Hyperaldosteronism: Conditions such as Conn's syndrome (primary hyperaldosteronism) lead to increased aldosterone levels, which promote H+ ion excretion and bicarbonate reabsorption by the kidneys, resulting in alkalosis.
    • Cushing's Syndrome: Excess cortisol in Cushing's syndrome can have similar effects to aldosterone, promoting H+ ion excretion and bicarbonate retention.

  10. Other Causes:

    • Milk-Alkali Syndrome: This condition results from excessive intake of calcium and absorbable alkali, leading to hypercalcemia, renal impairment, and metabolic alkalosis.
    • Genetic Disorders: Rare genetic conditions affecting renal tubular function can lead to inappropriate bicarbonate retention or H+ ion loss, contributing to metabolic alkalosis.

Summary:

Metabolic alkalemia results from an imbalance between acids and bases in the body, characterized by increased alkalinity due to either an elevation in bicarbonate levels or a reduction in hydrogen ions. Common causes include prolonged vomiting, diuretic use, excessive bicarbonate intake, and endocrine disorders like hyperaldosteronism. These conditions lead to direct loss of acids (H+ ions) or shifts in electrolytes that elevate bicarbonate levels or prompt renal compensation favoring bicarbonate retention and H+ ion excretion. Alkalemia can also arise from respiratory disturbances that lower CO2 levels through hyperventilation. Understanding and addressing the specific cause is crucial for appropriate treatment and management.
 
More details:

Cortisol – Cushing-Syndrom und Funktionsstörung des endokrinen Systems (Hypothalamus-Hypophysen-Nebennierenrinden-Achse (HPA-Achse)).

https://swaresearch.blogspot.com/2023/10/cortisol-endocrine-system-hypothalamic.html

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