The result is glucose in the urine glucose is a

. The result is glucose in the urine. Glucose is a solute that draws water into the
urine by osmosis. Thus, hyperglycemia causes a diabetic to produce a high volume of
glucose-containing urine.
13. Causes of Hypochloremia metabolic alkalosis
Hypochloremia is usually caused by excess use of loop diuretics, nasogastric suction, or
vomiting. Metabolic alkalosis is usually present with hypochloremia . Vomiting causes
loss of hydrochloric acid.
Metabolic alkalosis is primary increase in bicarbonate (HCO
3
−
) with or without
compensatory increase in carbon dioxide partial pressure (Pco
2
); pH may be high or
nearly normal. Metabolic alkalosis (retention of bicarbonate OR loss of hydrogen
ion)
**Common causes include prolonged vomiting , hypovolemia, diuretic use, and
hypokalemia.
H ypochloremia can contribute to the reduction in bicarbonate excretion by increasing
distal reabsorption and reducing distal secretion from the kidney. This usually occurs in
tandem with the volume depletion which occurs due to the acid loss from the stomach.
• Usually the result of hyponatremia or elevated bicarbonate concentration
• Develops due to vomiting and the loss of HCl
• Occurs in cystic fibrosis
Hypochloremic Metabolic Alkalosis
Hypochloremia
 Overhydration
 Hypoventilation (CO
2
retention), with increased CO
2
and HCO
3
- and compensatory
decrease in chloride
 Depression of central nervous system (CO
2
retention), with increased CO
2
and HCO
3
- and
compensatory decrease in chloride
 Pulmonary disease (CO
2
retention), with increased CO
2
and HCO
3
- and compensatory
decrease in chloride
 Chronic renal disease

 Diabetic ketosis
 Adrenal insufficiency (Cl - lost from kidney together with Na + )
 Hyperfunction of adrenal cortex (Cl - lost from kidney with K + )
 Over dosage with ACTH and cortisone (hypochloremic alkalosis) with loss of potassium
and hydrogen ion, causing increase in HCO
3
- and compensatory decrease in chloride
 Metabolic alkalosis (increased HCO
3
-
with compensatory decrease in chloride)
 Vomiting (loss of hydrogen ion, causing increased HCO
3
-
and compensatory decrease in
chloride); also loss of chloride in gastric fluid
 Fistulas of GI tract (gastric) with loss of hydrogen ion, causing HCO
3
- and compensatory
decrease in chloride; also loss of chloride in gastric acid
Chloride
Reference values:
Serum: 97-107 mmol/L
Erythrocytes: 52 mmol/L (thus, hemolysis lowers serum chloride)
Hyperchloremia
 Dehydration
 Hyperchloremic acidosis (loss of HCO
3
- due to diarrhea or renal tubular acidosis with
compensatory increase in chloride)
 Stimulation of respiratory center (drugs, hysteria, anxiety, fever, hyperventilation) causes
loss of CO
2
and decrease in HCO
3
- , with compensatory increase in chloride
 High altitudes (small effect which is due to hyperventilation), causing loss of CO
2
and
decrease in HCO
3
-
, with compensatory increase in chloride
14. Compensated of metabolic acidosis
Compensation for a metabolic acidosis is hyperventilation to decrease the arterial pCO
2
.
This hyperventilation was first described by Kussmaul in patients with diabetic