Original communication| Volume 75, ISSUE 2, P194-202, February 1974

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Intravenous infusion of hydrochloric acid for treatment of severe metabolic alkalosis

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      The acid-base balance of eight patients with severe metabolic alkalosis who failed to respond to treatment with potassium and sodium chloride infusion was successfully restored to normal by the intravenous infusion of hydrochloric acid. Prior to HCl administration, ammonium chloride, arginine hydrocholride, hemodialysis, and exchange blood transfusions were also given but had failed to correct the alkalosis. Each patient received from 150 to 1,200 mEq. of acid over a period of six hours to three days. Isotonic or hypertonic HCl solutions were given through a central venous catheter. No serious complications were encountered during this treatment. It is postulated that in cases of severe alkalosis particularly when associated with hypochloremia, direct infusion of hydrogen ion is desirable to neutralize the excess plasma bicarbonate, and sufficient chloride ion must be delivered in order to interrupt the vicious cycle of bicarbonate reabsorption and hydrogen ion secretion by the renal tubules. It is suggested that hydrochloric acid infusion is safe, and it should be administered to patients with hypochloremic alkalosis particularly after failure of conventional treatment.
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