Metabolic Alkalosis - Differential Diagnosis Algorithm - Urinary Chloride
• Cl- responsive metabolic alkalosis
- Kidney loss of Cl-: Remote use of loop or thiazide diuretics, Post-hypercapneic metabolic alkalosis
- Loss of Cl- outside the kidneys: Gastrointestinal (Vomiting/nasogastric suction, Congenital chloride diarrhea), Sweat (Cystic fibrosis)
• Cl- resistant metabolic alkalosis
- Normal/low blood pressure: Active diuretic use, Bartter syndrome, Gitelman syndrome, Hypomagnesemia
- Hypertension: Increased mineralocorticoid or mineralocorticoid-like effect)
• Normal gap metabolic acidosis: Chronic diarrhea, Kidney tubular acidosis
• Anion gap metabolic acidosis: Diabetic ketoacidosis, Starvation ketoacidosis, Alcoholic ketoacidosis, D-lactic acidosis, Chronic salicylate poisoning
• Normal acid-base status: LiCl use
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