Which medications in the drug class Acids are used in the treatment of Metabolic Alkalosis?

Updated: Dec 10, 2020
  • Author: Christie P Thomas, MBBS, FRCP, FASN, FAHA; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Acidic IV solutions are used to treat severe metabolic alkalosis. Seek the advice of nephrologist in severe alkalosis when HCl therapy or dialysis is contemplated.

Hydrochloric acid

IV HCl may be indicated in severe metabolic alkalosis (pH >7.55) or when NaCl or KCl cannot be administered because of volume overload or advanced renal failure. This approach may also be indicated if rapid correction of severe metabolic alkalosis is warranted (eg, in cases of cardiac arrhythmia, hepatic encephalopathy, digoxin toxicity). HCl is available in preparations of 0.1 and 0.2 M, which contain 100 mmol H+/L and 200 mmol H+/L, respectively.

Ammonium chloride (NH4Cl)

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.

This agent is available as 500-mg tablets and a 26.75% parenteral formulation for intravenous use. The parenteral formulation contains 5 mEq/mL (267.5 mg/mL).

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