How can a metabolic alkalosis ever persist?
The persistence of a metabolic alkalosis requires an additional process which acts to impair renal bicarbonate excretion. In our analogy, this would be something that increased the height of walls of the bucket. This means that two issues must to be considered when analysing a metabolic alkalosis: • Initiation: What process is initiating the disorder? • Maintenance: What process is maintaining the disorder? When discussing the ’cause’ of a metabolic alkalosis, note this term is used in several ways. For example it may be used to describe the initiating process, or the process maintaining the disorder or it can be used to refer to the combination of both processes, so be mindful of this when reading the rest of this section as otherwise you may become a little confused.
