Metabolic alkalosis may be caused either by the excessive loss of acid or intake of alkali. The latter may be iatrogenic or factitious, with the excessive intake of prescribed antacids (such as sodium bicarbonate for heartburn or peptic ulcer disease) - the 'milk-alkali' syndrome. The loss of acid-rich gastric secretions in severe vomiting, for example, in cases of gastric outlet obstruction (due to pyloric stenosis, or a consequence of peptic ulcer disease), also leads to alkalosis. Compensation is by reducing ventilation to promote retention of CO2 and thus balance the Henderson-Hasselbalch equation. Treatment is of the underlying condition rather than by administration of acid.
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