Management of Metabolic Alkalosis in Patients With Azotemia

Abstract

The association of spontaneous primary metabolic alkalosis with azotemia has received little attention. Its occurrence is not mentioned in several recently published texts in the field of acid-base, electrolyte, and fluid balance.^1-6 Spontaneous primary metabolic alkalosis is generally considered to be due to, or associated with, a state of potassium deficiency.^7,8 The need for potassium administration in the therapy of this abnormality is well recognized. There is, however, widespread reluctance to administer potassium, especially parenterally, to patients who are azotemic. This reluctance may perhaps be explained by the universal emphasis on total potassium restriction in acute renal failure. The occurrence and management of spontaneous primary metabolic alkalosis with azotemia observed in 42 patients is the subject of this report. Methods Procedures. —Arterial blood pH was measured under anaerobic conditions at 38 C with the use of a glass microelectrode and a Radiometer (M₄) pH meter. The following