Meanings of Metabolic Alkalosis

Metabolic alkalosis is a shift in pH in the blood and extracellular tissues above 7.45. The reason for this shift is primarily an increase in bicarbonate concentration, either due to accumulation of bicarbonate via the kidneys or due to the loss of acidic gastric juice during severe or chronic vomiting.

What is Metabolic Alkalosis?

In metabolic alkalosis, the body’s pH levels go haywire, which can wreak havoc on how the metabolism functions. The word “metabolic” indicates that the cause of this pH shift can also be found in the metabolism, i.e. in the metabolism. The counterpart to this would be respiratory alkalosis, which is caused by breathing. See AbbreviationFinder for abbreviations related to Metabolic Alkalosis.


The role of the kidneys is a decisive factor in the development of metabolic alkalosis: bicarbonate is an important buffer system in the blood, which has the sole task of regulating the pH value. To achieve this, a bicarbonate ion can combine with a proton (“acid”) and knock it out of circulation. It then turns into carbon dioxide and water, the carbon dioxide molecule can be exhaled through the lungs and is thus finally excreted. With the help of bicarbonate, acid can be drawn out of circulation, which is constantly produced in our body, for example during muscle work.

In order to get bicarbonate out of circulation, the kidney is required. This filters large amounts of bicarbonate out of the blood and then only gets as much bicarbonate back into the blood in its widely branched collecting tube system as is currently needed for buffering. If you mess up this complex regulated system, for example by taking diuretics, it can easily happen that too little bicarbonate is excreted and consequently the pH value of the blood changes to alkaline through acid binding – a metabolic alkalosis developed.

In addition to the side effects of diuretic therapy as one of the main causes of metabolic alkalosis, shifts in potassium and chloride levels can also be considered, which are also connected to the acid-base balance of the body via the kidneys.

Since chloride and bicarbonate are both negatively charged ions, they can be easily exchanged with each other via the cell wall – if the body lacks chloride, it can replace it with bicarbonate molecules for a short time, which then ensures electrical equality, but also leads to alkalosis. Chronic vomiting is a possible cause of this problem: gastric juice consists of hydrochloric acid, which is protons and chloride; Thus, acid is lost directly from the body and indirectly, thanks to the lack of chloride, bicarbonate is also saved in the kidneys and floods the metabolism.

Potassium, in turn, is exchanged for protons, so diseases with potassium deficiency can also lead to metabolic alkalosis. Hormonal disorders (mineralocorticoid excess) can be the cause here. Conversely, metabolic alkalosis also leads to an increased shift of potassium into the cells in exchange for acidic protons.

Symptoms, Ailments & Signs

The clinical picture of metabolic alkalosis is characterized by a drop in blood pressure, which is characterized, among other things, by weakness, confusion and abnormal sensations in the skin. Those affected feel a strong feeling of discomfort, which occurs suddenly and gets stronger over time. As a result of the pH imbalance, spasms and difficulty breathing occur.

In severe cases, life-threatening respiratory depression occurs . Metabolic alkalosis can also manifest itself through apathy, visual disturbances, ringing in the ears, feeling hot and cardiac arrhythmias. The clearest sign is the characteristic position of the hands, which are clenched and slightly bent forward.

A potassium deficiency can be detected during a medical examination. If not treated promptly, other health problems can occur. There is a risk that deficiency symptoms (e.g. fatigue and dizziness ) will appear. In addition, the cramps increase in intensity and sometimes cause severe pain in those affected.

If left untreated, metabolic alkalosis can lead to heart failure. Permanent damage to the internal organs and blood vessels cannot be ruled out either. With early treatment, however, serious complications like these can be reliably avoided. The cramps usually subside within a few days to weeks.

Diagnosis & History

The symptoms of metabolic alkalosis are mostly determined by the low potassium level: abnormal sensations on the skin, muscle weakness and dangerous cardiac arrhythmias can occur. As with respiratory alkalosis, cramps and the typical “pawed position” of the hands can also occur. Overall, severe metabolic alkalosis is quite rare and therefore often overlooked.

A simple collection of capillary blood to carry out a blood gas analysis (BGA) can reveal the problem: measurement of the pH value and bicarbonate concentration unmistakably indicate metabolic alkalosis, potassium and chloride values ​​can provide information about the cause.


In the worst case, this complaint can bring about the death of the patent. However, this is very rare and can be avoided with prompt and early treatment. Those affected suffer from severe breathing difficulties and a potassium deficiency. The lack of potassium negatively affects the health of the patient.

This leads to a general weakness, the patient feels a noticeable exhaustion. Likewise, the resilience drops significantly and cramps occur in the muscles. These spasms can cause severe pain and uncomfortable feelings, significantly reducing the patient’s quality of life. Confusion also occurs, so that normal thinking and acting is usually no longer possible for the person concerned.

If left untreated, it can also cause heart problems, which can lead to cardiac death. Treatment for this condition can be through IV fluids and other medications or supplements. There are no complications and the symptoms can be limited relatively well. If the treatment is successful, the life expectancy of the person affected is not reduced.

When should you go to the doctor?

Confusion, a general weakness and a decrease in the usual resilience are signs of an existing irregularity. If the symptoms persist or increase in intensity, a doctor is needed. If abnormal sensations or disturbances of perception of the skin occur, this is considered an indication of an existing disorder. If you experience tingling on the skin, an unpleasant feeling when touched or hypersensitivity, a doctor’s visit is advisable. A doctor should be consulted in the event of cardiac arrhythmia, a feeling of excessive heat development in the body and sweating.

Since untreated metabolic alkalosis can lead to premature death in severe cases, a doctor’s check-up should take place as soon as the first signs and symptoms appear. Hardening of the muscles, a reduction in muscle strength or a general feeling of pain in the body must be examined and treated. Apathy, exhaustion, functional disorders and problems with vision or hearing should also be checked out by a doctor.

Ringing in the ears, breathing and heart murmurs are worrisome and should be treated immediately by a doctor. A possible heart failure must be prevented as soon as possible. Cramps in the hands or an abnormality in the natural hand position are signs of a disease. If the hands are repeatedly bent forward slightly in everyday life, this is an indication of metabolic alkalosis.

Treatment & Therapy

The distinction between the different forms is crucial for the treatment of metabolic alkalosis:

In the case of a chloride and blood volume deficiency (e.g. after vomiting), the administration of sodium or potassium chloride as an infusion by a doctor is sufficient to stabilize the acid-base balance again.

If it is based on diuretic therapy, the drug in question should be discontinued or a so-called potassium-sparing diuretic should be given. If there are disorders of the hormone metabolism, further drug therapy and sometimes a surgical intervention are necessary.

Outlook & Forecast

With prompt and good medical care, the prognosis for metabolic alkalosis is good. The administration of medication alleviates the existing symptoms. The pH is regulated and there is an improvement in general health. As soon as side effects of the prescribed preparations occur, they are replaced with alternative products. Nevertheless, a chronic or unfavorable course of the disease can also develop.

If left untreated, metabolic alkalosis can lead to premature death. Health irregularities are increasing and at the same time there is a reduced quality of life. Expect severe pain, internal weakness, cognitive changes, and convulsions. If the patient refuses to cooperate with a doctor, his life expectancy is significantly reduced. In an advanced stage of the disease, various complications can also occur. Nevertheless, the survival of those affected is assured in these cases.

If the drug therapy does not work as desired, a surgical intervention is carried out. This is associated with risks, but it is the only way to help improve health in the case of an advanced disease or chronic symptoms. In most cases, long-term therapy is necessary to achieve lasting relief from the symptoms. The pH value must be checked at regular intervals and corrective measures are necessary if necessary.


To avoid the sometimes severe consequences of metabolic alkalosis, the only prophylactic recommendation is regular monitoring of diuretic therapy. In the case of severe or permanent vomiting, a BGA should also be carried out in order to be able to recognize and counteract disturbances in the acid-base balance in good time.


In most cases, no direct follow-up care is possible or necessary for metabolic alkalosis. Patients with this disease need treatment to avoid further symptoms and complications. If the alkalosis is not treated, the patient dies in most cases.

For this reason, early diagnosis and treatment of metabolic alkalosis have a very positive effect on the further course of the disease. If the diseases are treated by surgery, the patient must rest after such an operation and take care of his body. You should therefore refrain from strenuous activities or sporting activities.

Potassium can also be taken to relieve the symptoms of alkalosis. Patients should ensure regular intake. If the alkalosis was triggered by a drug, it is advisable to stop using that drug. This is the only way to fully treat the disease.

However, stopping medication should only be done after consulting a doctor. In some cases, the disease also reduces the life expectancy of the patient. However, this depends heavily on the underlying disease.

You can do that yourself

If there is a metabolic alkalosis, it is usually sufficient to stop taking the medication responsible. Other self-help measures focus on alleviating the individual symptoms.

A general weakness can be counteracted by exercise in the fresh air. Especially in the first few days after the treatment, the immune system has to get going again, which is why physical activity is particularly recommended here. Convulsions and confusion do not necessarily require treatment. The symptoms usually disappear on their own as soon as the alkalosis is overcome. This process can be accelerated by rest and bed rest. Those affected should sleep a lot in the acute phase and ideally take sick leave for two to three days.

Accompanying this, some resources from the household and nature can be used. Magnesium supplements and soothing teas (e.g. chamomile or lemon balm) help with cramps. Homeopathy recommends, among other things, the remedies Cuprum metallicum, Magnesium phosphoricum and Cina. If you are confused or have trouble concentrating, warm infusions or woodruff tea will help. Belladonna, Glonoinum and Rhus Toxicodendron are effective homeopathic alternatives.

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