THE RATIONAL USE OF I.V. HYDROCHLORIC ACID IN THE TREATMENT OF METABOLIC ALKALOSIS

A method for the assessment and management of factors both causing and maintaining a primary metabolic alkalosis is presented. During a 2-year period 65 patients with metabolic alkalosis were treated with saline and potassium chloride infusions. In four patients the alkalosis was refractory and required additional therapy. An infusion of hydrochloric acid 0.12-0.24 mol/litre through a central venous line corrected the alkalosis without causing haemolysis or tissue necrosis. The maximum rate of infusion suggested is 0.2 mmol H+.kg body wt " 1. ^ 1. With the introduction of potent diuretic agents to medical practice and with modern operative tech-niques permitting extensive thoracic and abdominal surgery, non-respiratory alkalosis may occur as a severe, even life-threatening, state (Wilson et al., 1972; Lawson, Butler and Ray, 1973). Characteristically, the alkalosis persists only if the patient has an associated unreplaced loss of saline or potassium chloride, and restoration of the effective extracellular fluid volume or correction of the total body potassium chloride defect allows correction of the pH abnormality without additional therapy. However, in the presence of cardiac, renal or hepatic failure, the alkalotic state may become refractory. Furthermore, in these conditions saline, potassium chloride or ammonium chloride infusions may be contraindicated. In a direct attempt to correct the acid-base defect without involving renal or hepatic mechanisms, i.v. hydrochloric acid has been used (Elkington an