All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we're going to talk about metabolic alcoholosis.

We're in part three of the Paloosa for all things metabolic and respiratory disturbances.

Josh, just a little caveat before we get into today, I just want to remind the listeners,

we're not trying to give you a postgraduate level approach.

We're starting with the basics, aren't we, Josh?

We want to make sure everybody has a level playing field so they don't screw it up.

No, I think we should do this at a PhD physical chemistry level.

I think that's what our listeners really need.

Ah, that is hyperbole. If you

didn't pick that one, ladies and gentlemen. Okay, metabolic alkalosis. So today, let's talk about

the nitty-gritty. So usually we see this in two types of situations. What can I expect it in,

Josh? As far as diagnosis, we have our typical algorithm here that we've been harping on.

So you can have an isolated metabolic alcoholosis where the bicarb is simply high, or you

can have a combined anti-gap metabolic acidosis plus a metabolic alcoholosis.

And in that situation, your delta delta is going to reveal what's going on.

So symptoms here, you're going to look for altered mental status, seizures if it's really

bad, and Josh, I'll touch on this in a second.

Symptomatic hypo-calcemia due to alkalosis. So remember, when you elevate your pH, calcium

shifts onto albumin and then reduces your ionized form. Same reason when you're biking really fast and you're

super stressed out and you're breathing quick and you need to start to get that carpal spasm.

Parasthenesias go along with that as well.

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