Hypochloremic metabolic alkalosis or strong ion alkalosis: A review

Abstract

Over the past 100 years numerous studies sought to elucidate the mechanisms of acid-base balance in humans and animals. Based on these investigations, different approaches have been developed among them, the model proposed by Henderson-Hasselbalch (H-H) is the most widespread in the medical and medical-veterinary community. In recent years, another method proposed by Stewart has gained importance, and it corresponds to the strong ion difference, which aims to take a broader look in order to understand the different processes involved in acid-base balance. Both in human and veterinary medicine, one of the most common acid-base disorder in ICUs is hypochloremic metabolic alkalosis, which results from vomiting in humans and from abomasal disorders in ruminants. This disorder can remain for long periods during which acidic urine occurs and it is known as paradoxical aciduria develops. This article reviews the different pathophysiological mechanisms occurring during this acid-base disorder and the different approaches to explain its occurrence.