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Saline-Resistant Metabolic Alkalosis or "Chloride-Wasting Nephropathy": Report of Four Patients with Severe Potassium Depletion

SERAFINO GARELLA, M.D.; JOSEPH A. CHAZAN, M.D., F.A.C.P.; and JORDAN J. COHEN, M.D., F.A.C.P.
[+] Article and Author Information

Presented in part April 25, 1969, at the 50th Annual Session of the American College of Physicians, Chicago, Ill.; and June 1969 at the IVth International Congress of Nephrology, Stockholm, Sweden.

Dr. Garella was supported in part by the Haffenreffer Family Fund Fellowship in Medical Research, Brown University and Rhode Island Hospital, Providence, R.L

▸Requests for reprints should be addressed to Serafino Garella, M.D., Division of Renal Diseases, Rhode Island Hospital, Providence, R. I. 02903


Providence, Rhode Island


Ann Intern Med. 1970;73(1):31-38. doi:10.7326/0003-4819-73-1-31
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"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.

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