SERAFINO GARELLA, M.D.; JOSEPH A. CHAZAN, M.D., F.A.C.P.; JORDAN J. COHEN, M.D., F.A.C.P.
"Saline resistant" metabolic alkalosis, which is characterized by the persistent urinary excretion of chloride in the presence of metabolic alkalosis, is known to occur in patients with hyperadrenocorticism. It has been suggested but not conclusively demonstrated that severe potassium depletion may produce this syndrome. Four patients with saline-resistant metabolic alkalosis and without hyperadrenocorticism had serum potassium concentrations of less than 2.0 mEq/liter. Observations in one patient showed that the metabolic alkalosis with chloriduria persisted until approximately 500 mEq of potassium had been retained. Total retained potassium was in the range of 1,000 mEq. Severe potassium depletion by itself may alter the renal tubular handling of chloride, resulting in chloride wasting with consequent metabolic alkalosis.
GARELLA S, CHAZAN JA, COHEN JJ. Saline-Resistant Metabolic Alkalosis or "Chloride-Wasting Nephropathy": Report of Four Patients with Severe Potassium Depletion. Ann Intern Med. ;73:31–38. doi: 10.7326/0003-4819-73-1-31
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Published: Ann Intern Med. 1970;73(1):31-38.
Endocrine and Metabolism, Fluid and Electrolyte Disorders, Nephrology.
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