What Causes Metabolic Alkalosis?

April 1, 2023

Metabolic alkalosis is a condition that develops in the blood when it has a pH level that is too high or too alkaline. The human body maintains the appropriate amount of acidity and alkalinity through mechanisms in the lungs and kidneys. Most mild cases of alkalosis and acidosis can be mediated by the lungs or kidneys, but some severe cases require medical treatment. Metabolic alkalosis occurs in one of four different types. There are two subtypes: chloride-resistant alkalosis and chloride-responsive alkalosis. Chloride-responsive alkalosis describes when an individual develops metabolic alkalosis from some loss of hydrogen ions, and chloride-resistant alkalosis develops when an individual's body experiences a shift of hydrogen ions out of the blood or retains an excess amount of bicarbonate ions.

There are several causes of metabolic alkalosis. Get familiar with them now.

Diabetes

One of the most prevalent causes of metabolic alkalosis is diabetes and the complications that develop from it. A diabetes patient is either unable to produce insulin or their body is unable to utilize the insulin that is produced. This leads to frequent instances of high blood glucose, especially if their diabetes is poorly or inadequately managed. Chronic high blood sugar can cause compounded damage to the tissues that make up the kidneys. Acid-base disorders, like metabolic alkalosis, occur when the affected individual experiences enough kidney damage to impair normal functionality. Another mechanism that can produce metabolic alkalosis in a diabetes patient is a condition referred to as diabetic ketoacidosis. The combination of compensatory mechanisms and medical treatment for the overly acidic blood can cause metabolic alkalosis if the blood pH becomes too high.

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Intense Exercise

An individual who exercises intensively can cause their body to go into a state of alkalosis when they experience an excessive increase in respiration rate. Increased respiration to an extreme degree can cause the blood to lose too much carbon dioxide, which results in a reduced quantity of hydrogen ions in the blood. The decrease in hydrogen concentration causes the pH of the blood to increase or alkalosis. Some individuals who engage in intense exercise and physical activities may develop a condition referred to as respiratory acidosis. Intense exercise usually only causes an individual with an underlying lung condition to experience this acid-base imbalance. When someone experiences this exercise-induced respiratory acidosis, their kidneys kick into action with a mechanism to mediate the condition. The kidneys in an affected individual secrete chloride and reabsorb bicarbonate. If this compensatory mechanism is overdone or aided by medical treatment, the patient can progress into metabolic alkalosis as a result.

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Kidney Disease

An individual affected by kidney disease can develop metabolic alkalosis as a complication of their organ failure. The kidneys are responsible for a large portion of maintaining the acid-base balance of an individual's body. The kidneys perform this function by the excretion of alkali compounds in excess of what the body needs. A kidney disease or renal failure patient has kidneys that do not function at a normal capacity, which impairs their ability to excrete any excess bicarbonate from their body. Many kidney disease patients undergo regular dialysis treatments until they can have a transplant. Dialysis methods are known to cause patients to experience issues with a lower than normal blood pH level or the condition of acidosis. This side effect of dialysis is often mediated with a high concentration of bicarbonate in the dialysate. This higher bicarbonate content and the inability of the kidneys to rid the body of it is what produces metabolic alkalosis in kidney disease patients.

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Misuse Of Laxatives

An individual can develop metabolic alkalosis if they engage in the misuse of over-the-counter or prescription laxative medications. Laxatives are utilized to help individuals pass stools that are too hard and difficult to pass without medical intervention. However, some individuals take laxative medications for recreational purposes, such as inducing weight loss. The misuse of laxatives causes diarrhea at a much greater frequency than normal. Laxative abuse can cause an individual to experience diarrhea-induced dehydration that leads to the depletion of their blood volume. The imbalance of acids and bases in the patient's body is due to a disproportionate loss of volume without congruent loss of bicarbonate. Volume loss can also cause alkalosis through a mechanism of renal compensation used to mediate the loss of blood volume. Laxative abuse can also cause a patient to experience acute kidney failure that can also contribute to the development of metabolic alkalosis.

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Heart Failure

An individual in heart failure may develop metabolic alkalosis as a complication. A heart failure patient has a heart that cannot pump blood around their body to all of their organs effectively. This impairment directly affects the amount of blood that reaches the tissues of the kidneys. This reduced renal blood flow causes problems with how the kidneys balance and excrete electrolytes and water. This mechanism produces activation of numerous responses by the brain, causing the release of certain hormones. These hormones produce a chain reaction of adverse effects on the electrolyte and cardiovascular homeostasis through interference with the normal pH stabilizing functionality of the kidneys. This process causes the loss of hydrogen ions and the reabsorption of bicarbonate in an affected individual's body, which increases the pH of their blood. Metabolic alkalosis of this nature is not an uncommon complication of heart failure.

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