Which symptom is associated with metabolic alkalosis?

• A. Restlessness followed by lethargy
• B. Confusion
• C. Nausea, vomiting, diarrhea
• D. Tremors, muscle cramps, tingling of fingers and toes

Answer: (D)

Metabolic alkalosis raises the blood pH and reduces the amount of ionized calcium in the blood. When ionized calcium falls, nerves and muscles become more excitable, leading to neuromuscular symptoms such as tremors, muscle cramps, and tingling or paresthesias in the fingers and toes. This distinct pattern of neuromuscular irritability is a hallmark of alkalosis, making the described combination the best fit. While restlessness, lethargy, or confusion can occur with various disturbances, and GI symptoms like nausea or vomiting can accompany alkalosis, the tremors, cramps, and tingling specifically reflect the calcium-related neuromuscular effects of alkalosis.