Metabolic alkalosis hydrochloric acid

Hydrochloric acid is widely used as an acidifying agent, in a variety of pharmaceutical and food preparations (see Section 16). It may also be used to prepare dilute hydrochloric acid, which in addition to its use as an excipient has some therapeutic use, intravenously in the management of metabolic alkalosis, and orally for the treatment of achlorhydria. See Section 17. 

Hjqiochloremia is common in gastrointestinal disease (Svendsen et al 1979), because of the loss of gastric hydrochloric acid in high volume reflux from the stomach (in proximal enteritis and grass sickness) and the secretion and/or lack of absorption of chloride in severe colitis. It may also occur in exhausted horse syndrome, chronic compensated respiratory acidosis and following furosemide (frusemide) administration. Hypochloremia in the absence of hyponatremia results in a metabolic alkalosis (Corley Marr 1998). The alkalosis associated with hypochloremia may also result in increased cellular uptake of potassium, leading to hypokalemia (Schaer 1999). 

Kwun K B, Boucherit T, Wong J et al 1983 Treatment of metabolic alkalosis with intravenous infusion of concentrated hydrochloric acid. American Journal of Surgery 146 328-330... 

Ammonium chloride has a limited role in the treatment of metabolic alkalosis. The liver converts ammonium chloride to urea and free hydrochloric acid ... 

Rowlands BJ, Tindall SE, Elliot DJ. The use of dilute hydrochloric acid and cimetidine to reverse severe metabolic alkalosis. Postgrad Med J 1978 54 118-123. 

In some cases, such as in pyloric stenosis, which involves obstruction between the stomach and the duodenum with consequent vomiting, leading to loss of hydrochloric acid and volume depletion, a diminished glomerular filtration rate leads to metabolic alkalosis. Because a low glomerular filtration rate affects the secretion of hydrogen ions, the ability to reabsorb bicarbonate is also affected. A low glomerular filtration rate also reduces the quantity of bicarbonate that is filtered. As such, the ability to correct acidosis or alkalosis is affected when glomerular filtration rate is reduced. 

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