Introduction: In the ICU, metabolic alkalosis is the most common acid-base disorder. A link has been observed between this disorder and an increased risk of death. However, this increased mortality is likely primarily due to the severity of the underlying disease rather than to metabolic alkalosis itself. Objective of the review: This article is a narrative review aimed at updating the diagnosis, treatment, and prognosis of metabolic alkalosis in the context of intensive care management. Key points of the review: Metabolic alkalosis often develops during a hospital stay and is often a consequence of ICU interventions. Mortality in patients with a pH of 7.55-7.56 is 41%, with a pH of 7.57-7.59 it is 47%, with a pH of 7.60-7.64 it is 65%, and with a pH of 7.65-7.70 it is 80%. Hypokalemia is a significant alteration in metabolic alkalosis, causing muscle weakness and paralysis, areflexia, ileus, ST-segment depression, the presence of a U wave, and QT prolongation. Conclusion: The underlying etiology has a significant influence on mortality associated with metabolic alkalosis. Therapeutic interventions have been limited to guiding adequate fluid management in patients with or without chloride sensitivity; the role of carbonic anhydrase inhibitor-type diuretics has grown, with varying evidence regarding their usefulness.