Intravenous hydrochloric acid in patients with metabolic alkalosis and hypercapnia
L. I. Worthley
During a seven-year period, 15 patients admitted to an intensive care unit
with a metabolic alkalosis resistant to saline and potassium chloride
infusions and with an arterial pH of greater than 7.44 and arterial carbon
dioxide pressure (PaCO2) of greater than 50 mm Hg, while breathing
spontaneously, were given hydrochloric acid at 200 mmol/24 h through a
central venous line until the arterial pH had decreased to less than 7.36
or PaCO2 had decreased to less than 40 mm Hg. Five patients without
respiratory failure had a significant decrease in PaCO2, pH, bicarbonate
Ion (HCO3-), and base excess (BE). Four patients with acute respiratory
failure had a significant decrease in PaCO2, HCO3-, and BE and an increase
in arterial oxygen pressure, indicating that in both of these patient
groups alveolar ventilation had improved. Six patients with chronic
respiratory failure had a significant decrease in pH, HCO3-, and BE,
although there was no significant change in PaCO2, indicating that in this
patient group alveolar ventilation could not be consistently increased in
response to a reduction in arterial pH.
