Dehydrated patient without clinically evident cause: A case report

Table 1 Main causes of metabolic alkalosis (modified from references[5-8])

Main causes of metabolic alkalosis
Chloride depletion syndromes
Gastric losses (vomiting, nasogastric tube)
Intestinal losses (congenital chloridrorrhea, villous adenomas)
Kidney losses (loop or thiazide diuretics)
Skin losses (cystic fibrosis)
Potassium depletion syndromes
Gastrointestinal losses (laxative abuse)
Kidney losses:
Primary hyperaldosteronism (11β-HSDH deficit, licorice, Liddle syndrome);
Secondary hyperaldosteronism (renovascular or malignant hypertension, hemangiopericytoma, Wilm’s tumor, Bartter and Gitelman syndrome,
thiazide and loop diuretics, hypercapnia quickly corrected)
Other causes
Repeated blood transfusion containing potassium citrate
Bone metastasis
Enteral nutrition with low chloride
Milk-alkali syndrome

11β-HSDH: 11β-hydroxysteroid-dehydrogenase.

Table 2 Bartter’s syndrome and cystic fibrosis: Differential diagnosis (modified from references[9-18])

	Cystic fibrosis	Bartter’s syndrome
ABE	Alkalosis	Alkalosis
FeNa+u	< 1%	> 1%
Na+pl	↓	↓
Cl-pl	↓	↓
Cl-u	↓	↑

ABE: Acid-Basic Equilibria; FeNa⁺_u: Urinary Fractional excretion of sodium; Na⁺_pl: Plasmatic Sodium; Cl^-_pl: Plasmatic Chloride; Cl^-_u: Urinary Chloride.