This paper is only available as a PDF. To read, Please Download here.
Abstract
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Changes in serum potassium and blood pH during clinical and experimental orthotopic liver transplantation.Surgery. 1971; 69: 419
- Experience in hepatic transplantation.in: W. B. Saunders Company, Philadelphia1969: 83-111
- Metabolic alkalosis treated with intravenous hydrochloric acid.Postgrad. Med. J. July, 1971; 47: 516-520
- The induction of metabolic alkalosis by correction of potassium deficiency.J. Clin. Invest. 1966; 45: 573
- The intravenous use of hydrochloric acid in the treatment of severe alkalosis.Am. Surg. 1968; 34: 551
- Correction of metabolic alkalosis by the kidney after isometric expansion of extracellular fluid.J. Clin. Invest. 1967; 46: 1558
- Myocardial function capacity in response to compensated and uncompensated respiratory alkalosis.in: ed. 2. Surg. Forum. 16. 1965: 186
- The need for chloride replacement in the correction of metabolic alkalosis due to vomiting.Br. J. Clin. Pract. 1967; 21: 570
- Coupled ion and fluid transport in the kidney.N. Engl. J. Med. 1972; 287: 913
- Respiratory adjustments to chronic metabolic alkalosis in man.J. Clin. Invest. 1968; 47: 188
- Metabolic alkalosis in patients with hypercalcemia.Metabolism. 1965; 14: 1137
- Liver transplantation in man.Transplant. Proc. 1972; 4: 781
- Influence of acid-base disturbance on total plasma calcium and evidence for a homeostatic role of thyrocalcitonin.Ann. Surg. 1966; 164: 1073
- The importance of the etiology of hypokalemic alkalosis in determining replacement therapy.Metabolism. 1965; 14: 1169
- Correction of metabolic alkalosis in man without repair of potassium deficiency.Am. J. Med. 1966; 40: 19
- The response of normal man to selective depletion of hydrochloric acid.Am. J. Med. 1966; 40: 10
- Aldosterone in metabolic alkalosis.J. Clin. Invest. 1967; 46: 1558
- Shock, seizures and coma with alkalosis during mechanical ventilation.Ann. Intern. Med. 1966; 65: 977
- Post traumatic alkalosis incidence and pathophysiology of alkalosis in surgery.Surgery. 1966; 60: 93
- Alkalosis in septic shock.Surgery. 1967; 62: 655
- Metabolic alkalosis.Arch. Intern. Med. 1965; 116: 729
- Physiology of the kidney and body fluids.in: Year Book Medical Publishers Inc, Chicago1972: 179
- Syndrome of metabolic alkalosis, hypokalemia, and hyperammonia in patients with cirrhosis.in: ed. 2. Surg. Forum. 18. 1967: 341
- Role of anious in metabolic alkalosis and potassium deficiency.N. Engl. J. Med. 1968; 279: 630
- The generation and maintenance of metabolic alkalosis.Kidney International. 1972; 1: 306
- An important syndrome of metabolic alkalosis in patients with cirrhosis, bleeding varices, and portacaval shunt.in: ed. 2. Surg. Forum. 17. 1966: 37
- The renal response to acid loads in metabolic alkalosis; an assessment of the mechanisms regulating acid excretion.J. Clin. Invest. 1963; 45: 562
- Relative roles of potassium and chloride in correction of hypokalemic, hypochloremic alkalosis.Johns Hopkins Med. J. 1967; 120: 148
- Severe alkalosis in critically ill surgical patients.Arch. Surg. 1972; 105: 197
Article info
Publication history
Received:
September 14,
1973
Identification
Copyright
© 1974 Published by Elsevier Inc.