Which is seen in gastric outlet obstruction?
A. Hypochloremic hypokalemic metabolic alkalosis.
B. Hyperchloremic hypokalemic metabolic alkalosis.
C. Hyperchloremic hypokalemic metabolic acidosis.
D. Hyperchloremic hypokalemic metabolic acidosis.
A. Hypochloremic hypokalemic metabolic alkalosis.
B. Hyperchloremic hypokalemic metabolic alkalosis.
C. Hyperchloremic hypokalemic metabolic acidosis.
D. Hyperchloremic hypokalemic metabolic acidosis.
Ans.
A. Hypochloremic hypokalemic metabolic
acidosis
The
five main major causes of metabolic alkalosis are.
A.
Vomiting or nasogastric suction
B.
Primary mineralocorticoid excess
C.
Loss of hydrogen ions –
D.
Renal Hydrogen Loss –
A.
Primary mineralocorticoid excess
B.
Loop or thiazide diuretics
C.
Posthypercapnic alkalosis
D.
Hypercalcemia and the milk-alkali syndrome
2.
Shift of hydrogen ions into intracellular space –
A.
Hypokalemia.
3.
Alkalotic agents -
A.
Alkalotic agents in excess, such as bicarbonate or antacids.
4.
Contraction alkalosis -
A.
Due to loss of water in the extracellular space from diuretic use.
B.
Sweat losses in cystic fibrosis
C. Villous adenoma or factitious diarrhea
The biochemical changes varies with
time, however in a patient with gastric outlet obstruction accompanied by
protracted non-bilious vomiting
persistently loosing gastric acid.
or prolonged gastric suctioning. The final picture of the biochemical
changes is as listed below:
Hypochloremia
Hyponatremia
Hypokalemia
Metabolic alkalosis and formation
/excretion of acidic urine urine with low PH, PH less than 5.5. , due to loss
of hydrogen ions in the urine.
In a patient with metabolic alkalosis,
the loss of acid in urine is not consistent with the expected response which is
the excretion of alkaline urine while conserving hydrogen ions in order to
reverse the metabolic alkalosis.
Therefore, the renal excretion of
acidic urine is paradoxical; hence, the phenomenon is termed paradoxical
aciduria.
