Metabolic Alkalosis

In lieu of a case study, I’m just going to touch a wee bit on the topic of metabolic alkalosis.

This is the condition where someone is too alkaline.

Yep, too alkaline. The extra cellular space does not have enough acid.

Recall that whenever we’re talking about “acid” this is only in reference to H+, i.e. hydrogen that has lost an electron. That’s what the word “acid” is referring, H+. In metabolic alkalosis there is not enough acid around the cells and there is too much bicarbonate. Stated another way, a low concentration of acid and a high concentration of base. The teeter tauter is lopsided.

When we talk acid/base balance in the human body we need to always think about lungs and kidneys. The lungs are the second by second mechanism to deal with acid/base imbalance.

When an overly alkaline situation presents itself, the lungs, or respiration rate, will slow down as the body says “hey, quit blowing off CO2, I could use some acid here”. CO2 is a blood gas, carbon dioxide, it leads to carbonic acid, which by the way will show up in saliva as an acid leaning pH as saliva reflects both free and combined carbon dioxide.

Which also means when saliva is moving more acid it could be telling you that contrary to thinking you have an “acid” issue, the issue may be quite the opposite. Respiration is automatic. You have no control over this. The body just does it to deal with its chemistry. You get too alkaline and your respiration rate will decrease. For point of reference, a normal breath rate per minute is around 14 breaths per minute, much lower than that and an alkalosis situation may be being revealed.

The lungs with its changing respiration to meet compensatory actions to balance the acid/base teeter tauter can only do 50 to 75% of the job. After that the kidneys step up.

In fluid dynamics within the body we are aware of major anions and cations in each fluid compartment that have milliequivalent values that must be balanced in the system. The kidneys preferentially will always hang onto sodium because for eons of time before modern junk food was created, salt was not high in the diet. The body is designed to hang onto it.

Now back to the idea of milliequivalents and balance, i.e. isotonicity, i.e. electric neutrality; for every sodium ion that the kidneys prefer to hang onto, either a potassium ion or a hydrogen ion will be let go.
In metabolic alkolosis, kidneys will decrease its sodium-hydrogen exchange because it is trying to hang onto its acid and it will move to sodium-potassium exchange.

This means potassium is getting dumped and if it’s not enough, the kidneys will even dump sodium to hang onto the acid (which by the way means increasing retention of ammonia, usually as ammonium chloride, with choride being further acidifying to the system).

To further hang onto acid, the body will dump bicarbonate. Bicarb is an anion. Anions and cations have to balance so when bicarb goes, potassium and/or sodium is going to go with it. Guess what happens to urine pH? It goes up.

So you see a pattern here: metabolic alkalosis noted by high urine pH and low saliva pH with a lowered respiration rate (which will also give you a longer breath hold time).

The body is compensating for milliequivalents of anions and cations being in the wrong space in the wrong amounts due to excess or deficiency at some level.

Bicarb, potassium and sodium can all be dumped while hydrogen and chloride are hung onto in an effort to bring body pH back down to normal.

There are a number of things which will bring about metabolic alkalosis. One such thing is excess consumption of bicarbonate. Know anyone that is taking baking soda these days because they believe they are too acid and need to alkalize themselves?

In alkalosis, potassium can move into the cells to an excess level leaving a deficit on the other side where sodium and hydrogen have moved. This effects urine, saliva and serum potassium levels, phosphorus levels, slows the tricarb metabolic pathway, increases beta oxidation, (which means ketosis which means metabolic acidosis – kind of like a compensatory move – with ketone excretion and now acid urine.

(There is a further form of metabolic alkalosis that can see low breath rate and low urine and saliva pH, and this is when potassium has been depleted, and from the prior reference of the kidney’s preferential treatment of holding onto sodium, if no potassium is available to be exchanged for that sodium, then hydrogen will be exchanged and the urine goes acid.)

There are many that have a belief that if urine and saliva both go acid that a person is overly “acidic” – but if breath rate is quite low, that is a giveaway that blood gas exchange is occurring for compensatory reasons and you know from kidney physics that the kidneys will be engaged in the specific aforesaid operations, screaming if you’re listening, that the body is in desperate need of some form of acid to balance the system.

If they are treated as if they have acidosis, simply because urine and saliva have low pH, it can exacerbate an already bad situation in numerous ways. Maybe not immediately apparent.

If there is insufficient acid in the system, a mineral like calcium will loose its ability to stay in solution and will precipitate out which can lead to soft tissue deposits of calcium, cataract issues, bursitis, rheumatoid arthritic-like pains, calcium carbonate crystallization on nerve endings, osteoarthritis with related stiffness in muscles and joints, bone spurs, irritability, hyper-excitability in the neuro-muscular complex, muscle spasms, and to an extreme tetany and seizures.

Though there are myriad mineral/ion relationships to keep in mind with reference to how the kidneys are operating which will reflect back to the extra and intracellular space, always remembering that the lungs engagement in these matters is of critical importance in order to discern the type of imbalance that is occurring on the teeter tauter – is it on the acid side or the alkaline side.

Where the urine and saliva pH goes will give clues to the type of acidosis/alkalosis issue. But even if urine and saliva is whacked to next year without a compensatory move in respiration, there is not a specific acidosis/alkalosis issue to be dealing with as there are other areas to look at in this big biochemical dog of a body we’re handling.

With that said, it is often the case that other things are likewise the cause for any alkalosis/acidosis situation that when addressed appropriately will move the acid/base compensatory mechanisms back to where it should be.

That’s one of the beauties of Flow System Auditing – it puts it all into perspective.

That’s all for now, more next time.

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