Why is there paradoxical aciduria in GOO?
HCO3 is excreted with Na and K until the overall volume deficit triggers an expansion of the extracellular volume rather than maintenance of pH. Na is resorbed, but K is lost via an aldosterone mediated mechanism and this leads to excretion of H ion resulting in “paradoxical aciduria” in an alkalotic patient.
Why there is paradoxical aciduria in pyloric stenosis?
Pyloric stenosis usually results in metabolic alkalosis with associated hypochloremia and hypokalemia due to a loss of hydrogen and chloride ions from vomiting gastric contents. However, if the dehydration is severe enough, paradoxical aciduria may occur.
How do you fix paradoxical aciduria?
Initial therapy should be aimed at volume expansion and replacing depleted strong ions, initially with normal sterile saline (NSS) infusion and potassium chloride (KCl). Aim to replace the volume deficit with NSS , followed by an infusion rate adequate to replace ongoing losses plus an additional 100 mL/h.
Why is there hypokalemia in gastric outlet obstruction?
Prolonged vomiting causes loss of hydrochloric acid and produces an increase of bicarbonate in the plasma to compensate for the lost chloride and sodium. The result is a hypokalemic hypochloremic metabolic alkalosis.
Why does paradoxical aciduria cause vomiting?
This is termed paradoxical aciduria. Because vomiting induces hypokalaemia, there is an overriding stimulus in the kidney for Na+ (and therefore water) retention. Na+ can only be resorbed in exchange for H+, H++ is therefore excreted in the urine, causing it to be acidic.
What is paradoxical alkaline urine?
This situation arises from the primary loss of gastric acid from repeated vomiting or drainage resulting in loss of chloride and potassium ions, as well as volume. Despite the metabolic alkalosis, the body still produces an acidic urine. The specific situation in this scenario is called “paradoxical aciduria”.
What electrolyte imbalance occurs in gastric outlet obstruction?
The classic electrolyte disorder of patients with long-standing gastric outlet obstruction is a hypochloremic, hypokalemic metabolic alkalosis.
What is the most common cause of gastric outlet obstruction?
Peptic ulcer disease used to account for up to 90% of cases of gastric outlet obstruction, and it is still the most common benign cause.
What is Hypochloremic alkalosis?
Hypochloremia is defined as a serum chloride level of less than 95 mEq/L. Hypochloremic alkalosis results from either low chloride intake or excessive chloride wasting.
What is the pathophysiology of gastric outlet obstruction?
Intrinsic or extrinsic obstruction of the pyloric channel or duodenum is the usual pathophysiology of GOO; the mechanism of obstruction depends upon the underlying etiology. Patients present with intermittent symptoms that progress until obstruction is complete. Vomiting is the cardinal symptom.
What are the symptoms of gastric outlet obstruction?
Nausea and vomiting are the cardinal symptoms of gastric outlet obstruction (GOO). Vomiting usually is described as nonbilious, and it characteristically contains undigested food particles. In the early stages of obstruction, vomiting may be intermittent and usually occurs within 1 hour of a meal.
What is the difference between gastric outlet obstruction and pyloric stenosis?
Pyloric stenosis is a narrowing of the pylorus, the opening from the stomach, into the small intestine. This type of blockage is also referred to as a gastric outlet obstruction. Normally, food passes easily from the stomach into the duodenum through a valve called the pylorus.
What causes Hypochloremic alkalosis?
Hypochloremic alkalosis results from either low chloride intake or excessive chloride wasting. Whereas low chloride intake is very uncommon, excessive chloride wasting often occurs in hospitalized children, usually as a result of diuretic therapy or nasogastric tube suctioning.
What causes hypochloremia?
Hypochloremia occurs when there’s a low level of chloride in your body. It can be caused by fluid loss through nausea or vomiting or by existing conditions, diseases, or medications. Your doctor may use a blood test to confirm hypochloremia. In mild cases, replenishing the chloride in your body can treat hypochloremia.
What is Bartter syndrome?
Bartter syndrome is a general term for a group of rare genetic disorders in which there are specific defects in kidney function. These defects impair the kidney’s ability to reabsorb salt and cause imbalances in various electrolyte and fluid concentrations in the body.
What is the pathophysiology of paradoxical aciduria?
Paradoxical aciduria typically occurs as a result of metabolic alkalosis and intrinsic mechanisms to correct acid-base imbalances. It most commonly develops in the setting of pathologies which result in excessive gastric acid losses and is often associated with severe metabolic derangements.
What is paradoxic Acuduria?
Paradoxic acuduria can be a feature of a primary metabolic alkalosis due to vomiting or sequestration of hydrochloric acid-rich gastric contents in all species, but particularly ruminants. In this example of a ruminant with abomasal displacement, hydrochloric acid-rich and water-rich secretions are sequestered in the displaced abomasum.
How does rapid rapidly induce systemic alkalinization in patients with ketoacidosis?
Rapidly induced systemic alkalinization due to either sodium-lactate or sodium-bicarbonate infusion in prolonged-fasted subjects with steady-state ketoacidosis was associated with a decrease in urine pH. This decrease in urine pH from 5.50 to 5.20 was the result of a significant decrease in urinary …