Major causes of metabolic alkalosis

Gastrointestinal hydrogen loss

Vomiting or nasogastric suction

Congenital chloride diarrhea (congenital chloridorrhea)

Renal hydrogen loss

Primary mineralocorticoid excess (primary hyperaldosteronism, Cushing syndrome [usually associated with ectopic ACTH] exogenous mineralocorticoids)

Mineralocorticoid excess-like states

Licorice ingestion

Liddle syndrome

Apparent mineralocorticoid excess

Loop or thiazide diuretics

Bartter or Gitelman syndrome

Status post chronic hypercarbia

Severe hypokalemia causing both intracellular hydrogen shift and renal hydrogen excretion

Villous adenoma (may manifest metabolic alkalosis, metabolic acidosis, or both)

Laxative abuse (may manifest metabolic alkalosis, metabolic acidosis, or both)

Alkali administration with reduced renal function

Calcium-alkali syndrome*

Bicarbonate ingestion/infusion with impaired kidney function

Contraction alkalosis

* Formerly called the milk-alkali syndrome. Now more commonly generated by ingestion of calcium carbonate rather than the historic combination of milk, cream, and "sippy powders" (sodium bicarbonate and alkaline calcium and bismuth salts).

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Major causes of metabolic alkalosis