Loss of gastric fluid

Loss of HCl in gastric fluid leads to a rise in serum [HCO₃^-] and reduction in body Cl^-.  The hypovolaemia stimulates the renin-angiotensin system leading to loss of H⁺ and K⁺ from the distal tubule.

The classic situation in paediatrics where this occurs is pyloric stenosis.

Management involves fluid resuscitation with NaCl and KCl.

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