Intravenous HCl or hemodialysis with a low-bicarbonate dialysate can be used to correct severe metabolic alkalosis when sodium or potassium chloride cannot be administered orally. Peritoneal dialysis using an isotonic sodium chloride solution as the dialysate can also correct metabolic alkalosis. Additionally, ammonium chloride can be administered to treat severe metabolic alkalosis related to chloride deficiency, as it is converted in the liver to ammonia and hydrochloric acid, releasing HCl to help correct the alkalosis.

30. RESPIRATORY ACIDOSIS

41. •Professors Thomas Mason and Jeffrey Kraut in
UCLA’s Department of Chemistry and School of
Medicine, Intravenous HCl is indicated in severe
metabolic alkalosis (pH >7.55) or when sodium
or potassium chloride cannot be administered
because of volume overload or advanced renal
failure.

42. • Both peritoneal dialysis and hemodialysis can be used with
certain modifications of the dialysate to correct metabolic
alkalosis.With hemodialysis, metabolic alkalosis may be
corrected by using a low-bicarbonate dialysate (bicarbonate
can be as low as 18 mmol/L). Otherwise, acetate-free
biofiltration (buffer-free dialysate), in which bicarbonate is
not present in the dialysate but is infused separately as
needed, may be used. In peritoneal dialysis, dialysis can be
performed using isotonic sodium chloride solution as the
dialysate.

43. •Mohammed Al-Jaghbeer, John A. Kellum
Nephrology Dialysis Transplantation, Volume 30,
Issue 7, July 2015 Reveals that Ammonium
chloride is administered to correct severe
metabolic alkalosis related to chloride deficiency.
NH4Cl is converted to ammonia and HCl by the
liver. By releasing HCl, NH4Cl may help correct
metabolic alkalosis.