Metabolic Alkalosis

Authored by Chris McDermott, APRN, practicing with autonomous authority in Florida

Introduction

Metabolic alkalosis is a disruption in the body’s acid-base homeostasis, characterized by a rise in blood pH due to excessive loss of hydrogen ions (acid) or an accumulation of bicarbonate (base). Though commonly overshadowed by acidosis-related conditions, alkalosis can impair vital physiological functions—including enzymatic activity, muscle contraction, electrolyte transport, and nervous system stability.
At Intercoastal Health, we evaluate metabolic alkalosis using a functional medicine telehealth framework, aiming to uncover the root causes of the imbalance and restore optimal cellular function through personalized diagnostics, nutrition, supplementation, and lifestyle strategies.

What Is Metabolic Alkalosis?

Metabolic alkalosis occurs when blood pH exceeds 7.45, typically due to:

• A loss of acid (e.g., through vomiting or diuretics)
  
• An increase in base (e.g., excessive bicarbonate intake)
  
  

This elevated pH alters the electrical gradients across cells and can impair multiple organ systems. Since many physiological processes depend on a narrow pH range (approximately 7.35–7.45), even small deviations can produce wide-ranging symptoms.

Symptoms of Metabolic Alkalosis

Symptoms may vary depending on the severity and cause of the alkalosis. In functional medicine, many of these symptoms are evaluated as potential markers of underlying biochemical imbalances or micronutrient deficiencies.
Common Symptoms Include:

• Confusion, dizziness, or mental fog
  
• Nausea, vomiting, or indigestion
  
• Muscle cramps, tremors, or tingling (especially in fingers or toes)
  
• Fatigue, especially in the morning
  
• Slow heart rate or palpitations
  
• Cold, clammy extremities
  
• Headaches localized to the temples
  
• Joint or muscle pain
  
• Dry skin, pallor, and introverted or depressive mood
  
• Bad breath or bitter taste in the mouth
  
• Constipation or sluggish digestion due to low stomach acid
  
• Sluggishness and poor stress resilience
  
  

Functional Evaluation and Biomarkers

At Intercoastal Health, identifying metabolic alkalosis involves assessing a combination of laboratory markers, clinical history, and systemic patterns.

Root Causes of Metabolic Alkalosis

Functional medicine explores metabolic alkalosis beyond isolated lab values—seeking to uncover systemic contributors and interconnected dysfunctions. Common root causes include:

1. Loss of Hydrogen Ions
   Prolonged vomiting or nasogastric suction removes hydrochloric acid (HCl), leading to net alkalinity and chloride depletion.
   
2. Excessive Bicarbonate Intake
   Overuse of antacids or alkaline water increases systemic base.
   
3. Hypokalemia
   Often results from diuretics, diarrhea, or excess licorice intake—impairing renal acid excretion.
   
4. Mineralocorticoid Excess
   Conditions like primary hyperaldosteronism stimulate sodium reabsorption and hydrogen/potassium loss—consider evaluation for chronic kidney disease.
   
5. Chloride Depletion
   Linked with vomiting, diuretic use, or poor dietary intake.
   
6. Use of Diuretics
   Especially loop and thiazide diuretics, which increase renal loss of H⁺, K⁺, and Cl⁻.
   
7. Gastric Hypochlorhydria
   Low stomach acid impairs digestion—often from PPIs or chronic stress.
   
   

Health Implications of Chronic Alkalosis

When metabolic alkalosis persists without resolution, it can contribute to secondary complications:

• Cardiac arrhythmias and altered blood pressure
  
• Muscle cramps, tetany, and peripheral paresthesias
  
• Impaired renal bicarbonate excretion and electrolyte loss
  
• Hypochlorhydria leading to malabsorption and dysbiosis
  
• Potential impacts on osteoporosis through chronic electrolyte depletion
  
  

Medication and Substance-Induced Alkalosis

Functional Medicine Treatment at Intercoastal Health

1. Comprehensive Assessment
   
   • Medication, diet, hydration, and GI symptom review
     
   • Lab evaluation of ABG, electrolytes, and adrenal function
     
2. Restore Electrolyte Balance
   
   • Replenish potassium and magnesium
     
   • Replace chloride (e.g., with sodium or potassium chloride)
     
3. Correct Lifestyle and Dietary Factors
   
   • Reduce antacid and alkaline-water use
     
   • Support stomach acid with digestive enzymes or betaine HCl
     
   • Increase chloride-rich foods: sea salt, celery, seaweed
     
4. Targeted Supplementation
   
   • Betaine HCl for hypochlorhydria
     
   • Mineral repletion: potassium, magnesium
     
   • Adaptogens (e.g., ashwagandha) for adrenal support
     
5. Address Adrenal and Renal Function
   
   • Evaluate for hyperaldosteronism if indicated
     
   • Support kidney detox and acid-base regulation
     
     

Monitoring and Long-Term Care

Patients with recurrent alkalosis require ongoing evaluation:

• Routine monitoring of HCO₃⁻, Cl⁻, K⁺, and ABG
  
• Dietary guidance on electrolyte-rich foods
  
• Adjustment of diuretics or acid-suppressing medications
  
• Follow-up every 3–6 months or as clinically indicated