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Milk Alkali Syndrome

Triad of hypercalcemia, metabolic alkalosis and AKI associated with ingestion of calcium and alkali

Ca2+ has the following effects on kidney

-Vasoconstriction decreases the GFR

-Blockage of the ADH responsive water reabsorbtion in the collecting ducts

-Inhibition of Na/K/Cl2 co-transported in TAL

Diuresis causes a contraction alkalosis. Hypovolemia will activate the RAAS system, increasing aldosterone, subsequently increasing absorption of bicarb and increased excretion of H+ ions

Chloride Sensitivity

Three most common types of Metabolic Alkalosis are

-Vomiting

-Diuretic Use

-Mineralocorticoid excess

In confusing cases a urinary chloride concentration can help differentiate the different causes

In cases where the cause of the alkalosis causes a hypovolemic state the urinary chloride would be expected to be low

Low Urinary Chloride indicates that an alkalosis will likely be resolved with the administration of NS

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