Hydrochloric acid for treating metabolic alkalosis

Area of Science:

• Nephrology
• Critical Care Medicine
• Clinical Chemistry

Background:

• Severe metabolic alkalosis presents a significant clinical challenge, particularly in critically ill surgical patients.
• Traditional treatments may require substantial fluid volumes, posing risks for patients with fluid restrictions.
• Intravenous hydrochloric acid (HCl) infusion offers a potential alternative for managing severe metabolic alkalosis.

Observation:

• Six patients with severe metabolic alkalosis underwent treatment with intravenous HCl infusion via a central venous catheter.
• Therapy initiation was based on arterial pH > 7.45, base excess (BE) > +7 mmol/L, or PaCO2 > 50 mmHg.
• Dosage was calculated using the BE formula, with two-thirds administered to prevent excessive acid loading.

Findings:

• Intravenous HCl infusion led to significant reductions in arterial pH and base excess.
• Moderate changes in PaCO2 were observed, reflecting diverse ventilatory statuses.
• All monitored laboratory parameters, including electrolytes and blood counts, remained within normal limits, with no reported complications.

Implications:

• Intravenous HCl infusion is a safe, time-saving, and effective treatment for severe metabolic alkalosis.
• This method requires less volume for correction, making it advantageous for fluid-restricted patients.
• The rapid response observed suggests HCl infusion is a valuable therapeutic option for critically ill surgical patients.