Treatment of Metabolic Alkalosis With Intravenous Infusion of Concentrated Hydrochloric Acid

The Air‐Bubble Method of Locking Central‐Vein Catheters with Acidified, Concentrated Sodium Chloride as a Bactericidal Agent: In Vitro Studies

“…In regard to the low pH, concentrated hydrochloric acid (HCl) has been used to treat severe metabolic alkalosis [44][45][46][47][48][49], metabolic alkalosis combined with respiratory acidosis [50,51], and severe metabolic alkalosis resulting from citrate dialysis [52]. Most authors used 0.15 m solutions in distilled water (pH 1.5, 300 mOsm/kg).…”

“…Most authors used 0.15 m solutions in distilled water (pH 1.5, 300 mOsm/kg). The highest concentration and infusion rate of HCl was studied by Kwun et al [46], with a 1.0 m HCl solution (pH 0.0) and an infusion rate of 16.6 mmol/s for several hours. They did not observe any side effects.…”

Treatment of Severe Metabolic Alkalosis with Continuous Renal Replacement Therapy

“…In refractory cases of severe chloride depletion alkalosis (pH > 7.55) or when immediate correction is necessary (e.g., cardiac arrhythmia or hepatic encephalopathy), treatment options include the use of HCl infusion 8,9 or renal replacement therapy (RRT). 10 Two other agents, ammonium chloride and arginine hydrochloride, have been used for treatment of metabolic alkalosis.…”

“…Hydrochloric acid infusion requires a central venous catheter and frequent monitoring of arterial blood gases and electrolytes. 8,9 The total amount of HCl required (not accounting for ongoing losses) can be estimated from the volume of distribution of bicarbonate (HCO 3 ) in metabolic alkalosis (approximately equal to 50% of lean body weight in kg) times the bicarbonate excess per liter (Equation 1 in Appendix). 15 In our patient, neither the renal failure nor the metabolic alkalosis improved after 30 hours despite intravenous sodium chloride, potassium chloride repletion, and PPI infusion.…”

Air‐Bubble Method of Locking Central‐Vein Catheters for Prevention of Hub Colonization: A Pilot Study

“…The authors observed systemic changes related to hypernatremia and the hyperosmolar state, but did not report any local side effects in the vein. The amount of concentrated saline that can be injected in the air-bubble method is more than 1000 times lower than that used by Tseng's group and more than 80 times lower than that used by Gong et al Kwun et al [12] used 1.0 m HCl (pH 0.0) and infused 16.6 mmol/s for several hours. They did not observe any side effects.…”