Hydrochloric Acid Infusion for the Treatment of Metabolic Alkalosis in Surgical Intensive Care Unit Patients

Guffey, Jason D; Haas, Curtis E.; Crowley, Amber; Connor, Kathryn; Kaufman, David

doi:10.1177/1060028018754389

Cited by 10 publications

(4 citation statements)

References 24 publications

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“…Besides treatment of the underlying conditions, correction of MAlk has been achieved using the CA inhibitor ACZ, which by itself results in MAc [79] , by intravenous infusion of HCl [80] , or (if MAlk follows loss of gastric acid) the use of H2-receptor agonists to prevent alkaline tide [81] (see section 4.7.2).…”

Section: Systemic Acid-base Disturbancesmentioning

confidence: 99%

The therapeutic importance of acid-base balance

Quade

Parker

Occhipinti

2021

Biochemical Pharmacology

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Baking soda and vinegar have been used as home remedies for generations and today we are only a mouse-click away from claims that baking soda, lemon juice, and apple cider vinegar are miracles cures for everything from cancer to COVID-19. Despite these specious claims, the therapeutic value of controlling acid-base balance is indisputable and is the basis of Food and Drug Administration-approved treatments for constipation, epilepsy, metabolic acidosis, and peptic ulcers. In this narrative review, we present evidence in support of the current and potential therapeutic value of countering local and systemic acid-base imbalances, several of which do in fact involve the administration of baking soda (sodium bicarbonate). Furthermore, we discuss the side effects of pharmaceuticals on acid-base balance as well as the influence of acid-base status on pharmacokinetic properties of drugs. Our review considers all major organs systems as well as information relevant to several clinical specialties such as anesthesiology, infectious disease, oncology, dentistry, and surgery.

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Section: Systemic Acid-base Disturbancesmentioning

confidence: 99%

The therapeutic importance of acid-base balance

Quade

Parker

Occhipinti

2021

Biochemical Pharmacology

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“…Iatrogenic chloride supplementation, such as with hydrochloric acid infusions (used previously to treat metabolic alkalosis), hypertonic saline or large volume extracellular fluid expansion with normal saline (based on in vitro studies) can all cause a hyperchloraemic metabolic acidosis, though not a serum hypokalaemia 7–10. This cause can be discounted based on the patient’s history.…”

Section: Differential Diagnosismentioning

confidence: 99%

Zonisamide-induced distal renal tubular acidosis and critical hypokalaemia

MacMahon

Kelly

2023

BMJ Case Rep

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A woman in her 20s presented with rapidly progressive muscle weakness and a 1-month preceding history of fatigability, nausea and vomiting. She was found to have critical hypokalaemia (K+1.8 mmol/L), a prolonged corrected QT interval (581 ms) and a normal anion gap metabolic acidosis (pH 7.15) due to zonisamide-induced distal (type 1) renal tubular acidosis. She was admitted to the intensive care unit for potassium replacement and alkali therapy. Clinical and biochemical improvement ensued, and she was discharged after a 27-day inpatient stay.

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“…It is important to prevent hypokalemia when using this medication. If this is unsuccessful and the pH is >7.55 with a HCO 3 >35 meq/L, HCL if available can be infused via a central vein (66); 0.1 N HCL in sterile water will supply 100 meq/L H + . This can be infused at 100 ml/h.…”

Section: Metabolic Alkalosismentioning

confidence: 99%

Acid-Base Disorders in the Critically Ill Patient

Achanti

Szerlip

2022

CJASN

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Acid-base disorders are common in the intensive care unit. By utilizing a systematic approach to their diagnosis, it is easy to identify both simple and mixed disturbances. These disorders are divided into four major categories: metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis. Metabolic acidosis is subdivided into anion gap and non–gap acidosis. Distinguishing between these is helpful in establishing the cause of the acidosis. Anion gap acidosis, caused by the accumulation of organic anions from sepsis, diabetes, alcohol use, and numerous drugs and toxins, is usually present on admission to the intensive care unit. Lactic acidosis from decreased delivery or utilization of oxygen is associated with increased mortality. This is likely secondary to the disease process, as opposed to the degree of acidemia. Treatment of an anion gap acidosis is aimed at the underlying disease or removal of the toxin. The use of therapy to normalize the pH is controversial. Non–gap acidoses result from disorders of renal tubular H+ transport, decreased renal ammonia secretion, gastrointestinal and kidney losses of bicarbonate, dilution of serum bicarbonate from excessive intravenous fluid administration, or addition of hydrochloric acid. Metabolic alkalosis is the most common acid-base disorder found in patients who are critically ill, and most often occurs after admission to the intensive care unit. Its etiology is most often secondary to the aggressive therapeutic interventions used to treat shock, acidemia, volume overload, severe coagulopathy, respiratory failure, and AKI. Treatment consists of volume resuscitation and repletion of potassium deficits. Aggressive lowering of the pH is usually not necessary. Respiratory disorders are caused by either decreased or increased minute ventilation. The use of permissive hypercapnia to prevent barotrauma has become the standard of care. The use of bicarbonate to correct the acidemia is not recommended. In patients at the extreme, the use of extracorporeal therapies to remove CO2 can be considered.

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Hydrochloric Acid Infusion for the Treatment of Metabolic Alkalosis in Surgical Intensive Care Unit Patients

Abstract: HCl was effective for treating metabolic alkalosis, and no serious adverse events were seen. In this clinical setting, the baseline chloride ion deficit and SIDa were not useful for prediction of total HCl dose requirement, and serial monitoring of response is recommended.

Cited by 10 publications

References 24 publications

The therapeutic importance of acid-base balance

The therapeutic importance of acid-base balance

Zonisamide-induced distal renal tubular acidosis and critical hypokalaemia

Acid-Base Disorders in the Critically Ill Patient

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