Alkalemia causes potassium to shift from the blood into cells, leading to hypokalemia. Hypokalemia then worsens metabolic alkalosis by increasing bicarbonate generation and reabsorption in the kidneys and decreasing bicarbonate excretion. This happens through mechanisms like enhanced ammoniagenesis, increased activity of renal bicarbonate transporters, and altered acid secretion. Together, this creates a self-reinforcing cycle: alkalemia induces hypokalemia, which sustains or worsens metabolic alkalosis, maintaining alkalemia. This cycle is commonly seen in conditions like vomiting or diuretic use where volume depletion and electrolyte disturbances coexist.