Professional and Linguistic Assessments Board (PLAB) Practice Exam

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What finding is characteristic of hypokalemic metabolic alkalosis?

  1. Elevated blood potassium levels

  2. Low blood pH

  3. Increased bicarbonate levels

  4. Normal acid-base balance

The correct answer is: Increased bicarbonate levels

In the context of hypokalemic metabolic alkalosis, increased bicarbonate levels are characteristic of the condition. Metabolic alkalosis occurs when there is an excess of bicarbonate in the blood, leading to an increase in blood pH. This can happen due to various factors such as vomiting, which removes hydrochloric acid from the stomach, or excessive diuretic use, particularly thiazide and loop diuretics, that can cause potassium loss and subsequently increase bicarbonate reabsorption in the kidneys. In hypokalemic metabolic alkalosis specifically, the depletion of potassium contributes to the metabolic alkalosis. The low potassium levels lead to a shift in bicarbonate handling by the kidneys and can promote the reabsorption of bicarbonate while impairing its excretion, resulting in elevated bicarbonate levels in the blood. This increase in bicarbonate aligns with the definition of metabolic alkalosis, thus confirming why elevated levels of bicarbonate are a critical finding in this condition. Understanding the role of bicarbonate in acid-base disorders, particularly in how it interacts with potassium levels, helps clarify the relationship between electrolyte imbalances and pH changes in the body.