Metabolic alkalosis is defined as an increase in blood pH to more than 7.45 and serum bicarbonate greater than 26 mmol/L. Metabolic alkalosis is the most common acid-base disturbance in hospitalized patients. It usually occurs due to an underlying predisposing condition, which includes reduced effective arterial blood volume, chloride depletion, hypokalaemia, hypoalbuminemia, hyperaldosteronism, or combinations of these factors. Severe metabolic alkalosis can have deleterious consequences and contribute to organ dysfunction, manifesting generally as agitation, disorientation, seizures, and coma. Increased morbidity and mortality are observed with severe alkaline blood pH, especially when it is associated with other life-threatening conditions like sepsis, acute coronary events, and stroke. Here, we report two cases: a 68-year-old man and a 19-year-old female, both presenting with severe metabolic alkalosis. The 68-year-old man, with underlying comorbid conditions, died, while the young woman survived, highlighting the importance of underlying comorbid conditions in elderly patients, which can determine mortality in such cases.

Keywords. Contraction alkalosis, Sepsis, Nephrotic syndrome, Diuretics

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