Hydrochloric acid infusion for treatment of metabolic alkalosis associated with respiratory acidosis

Critical Care Medicine
S BrimioulleR J Kahn

Abstract

Hypercapnia due to respiratory failure can be more severe when accompanied by coexistent metabolic alkalosis. We therefore tested the hypothesis that hydrochloric acid (HCl) infusion could improve PaCO2 in 15 critically ill patients admitted with mixed respiratory acidosis and metabolic alkalosis, and a pH of between 7.35 and 7.45. HCl was infused at a constant rate of 25 mmol/h until the bicarbonate concentration decreased less than 26 mmol/L, or until the pH decreased less than 7.35 (initial pH greater than 7.40) or 7.30 (initial pH less than 7.40). Administration of 170 +/- 53 mmol of HCl decreased the bicarbonate concentration from 34 +/- 3 to 25 +/- 2 mmol/L (p less than .001), the pH from 7.41 +/- 0.03 to 7.33 +/- 0.02 (p less than .001), and the PaCO2 from 54 +/- 8 to 48 +/- 8 torr (p less than .001). Postinfusion PaCO2 could be predicted accurately from the initial status of the patients (r = .95, p less than .001) except in one patient with fixed hypercapnia. PaCO2 increased from 77 +/- 19 to 94 +/- 24 torr (p less than .001) and PaO2/PAO2 increased from 59 +/- 17 to 66 +/- 17% (p less than .001). The effects of HCl were still present 12 h after the end of the infusion. No complications related to the acid infusion wer...Continue Reading

Citations

Sep 8, 2005·Southern Medical Journal·Ian B BuchananBruce A Cairns
Sep 16, 2011·Critical Care : the Official Journal of the Critical Care Forum·Nicholas HemingSaïk Urien
Aug 8, 2012·Critical Care : the Official Journal of the Critical Care Forum·Nicholas HemingChristophe Faisy
Nov 24, 1999·Critical Reviews in Clinical Laboratory Sciences·N R Webster, V Kulkarni
Apr 29, 2014·Emergency Medicine Clinics of North America·Jennifer T Soifer, Hyung T Kim
Mar 14, 2013·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Aldo J Peixoto, Robert J Alpern
Jan 24, 2018·The Annals of Pharmacotherapy·Jason D GuffeyDavid C Kaufman
Mar 1, 1991·DICP : the Annals of Pharmacotherapy·D F DriscollB R Bistrian

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