Avoid excessive licorice candy or licorice root supplements
Avoid excessive antacids (Tums, Rolaids) without medical guidance
Gentle activity as tolerated; no strenuous exercise until follow-up
Follow-up instructions
Repeat blood test (metabolic panel) within 24–48 hours of discharge
Follow up with your primary care doctor within 1 week
If on water pills — diuretic dose may have been adjusted; confirm new dose before leaving
Return to emergency department immediately for
Persistent vomiting or inability to keep fluids down
Palpitations, irregular heartbeat, or chest pain
Muscle weakness or inability to walk
Confusion, difficulty speaking, or altered level of consciousness
Seizures or muscle spasms (hands curling, face twitching)
Fainting or near-fainting episodes
Inability to urinate for more than 8 hours
References
Guidelines and key sources
Primary references
Do C, Vasquez PC, Soleimani M — Metabolic Alkalosis Pathogenesis, Diagnosis, and Treatment: Core Curriculum 2022; American Journal of Kidney Diseases 2022; PMID 35525634
Berend K, de Vries AP, Gans RO — Physiological Approach to Assessment of Acid-Base Disturbances; New England Journal of Medicine 2014; DOI 10.1056/NEJMra1003327
Adrogué HJ, Madias NE — Management of Life-Threatening Acid-Base Disorders; New England Journal of Medicine 1998; DOI 10.1056/NEJM199801083380207
Peixoto AJ, Alpern RJ — Treatment of Severe Metabolic Alkalosis in a Patient With Congestive Heart Failure; American Journal of Kidney Diseases 2013; PMID 23481366
Lukomskyj AO, Partyka CL — Severe Multifactorial Metabolic Alkalosis in the Emergency Department: A Case Report; Journal of Emergency Medicine 2024; PMID 37867035
Byrne AL et al — Peripheral Venous Blood Gas Analysis for the Diagnosis of Respiratory Failure, Hypercarbia and Metabolic Disturbance in Adults; Cochrane Database of Systematic Reviews 2025
Seifter JL — Integration of Acid-Base and Electrolyte Disorders; New England Journal of Medicine 2014; DOI 10.1056/NEJMra1215672
Achanti A, Szerlip HM — Acid-Base Disorders in the Critically Ill Patient; Clinical Journal of the American Society of Nephrology 2023; PMID 35998977
Gennari FJ — Hypokalemia; New England Journal of Medicine 1998; DOI 10.1056/NEJM199808133390707
Guideline recommendations
Evidence levels applied
ACEP Level C recommendation for hydrochloric acid infusion in refractory severe alkalemia
Class I recommendation for IV saline in chloride-responsive metabolic alkalosis based on physiologic rationale
Class I recommendation for spironolactone in primary hyperaldosteronism
Class IIb recommendation for acetazolamide in volume-overloaded patients (observational evidence)
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.