Metabolic Alkalosis: A Brief Pathophysiologic Review

Clin J Am Soc Nephrol. 2020 Dec 7;15(12):1848-1856. doi: 10.2215/CJN.16041219. Epub 2020 Jun 25.


Metabolic alkalosis is a very commonly encountered acid-base disorder that may be generated by a variety of exogenous and/or endogenous, pathophysiologic mechanisms. Multiple mechanisms are also responsible for the persistence, or maintenance, of metabolic alkalosis. Understanding these generation and maintenance mechanisms helps direct appropriate intervention and correction of this disorder. The framework utilized in this review is based on the ECF volume-centered approach popularized by Donald Seldin and Floyd Rector in the 1970s. Although many subsequent scientific discoveries have advanced our understanding of the pathophysiology of metabolic alkalosis, that framework continues to be a valuable and relatively straightforward diagnostic and therapeutic model.

Keywords: alkalosis; bicarbonates; electrolytes; musculoskeletal abnormalities.

Publication types

  • Review

MeSH terms

  • Acid-Base Equilibrium*
  • Alkalosis / blood
  • Alkalosis / diagnosis
  • Alkalosis / physiopathology*
  • Alkalosis / therapy
  • Animals
  • Bicarbonates / blood*
  • Biomarkers / blood
  • Chlorides / blood
  • Humans
  • Hydrogen-Ion Concentration
  • Models, Biological
  • Prognosis


  • Bicarbonates
  • Biomarkers
  • Chlorides