When the pH exceeds 7.55 and severe clinical signs of alkalosis are present, acid replacement may be warranted, although it is hazardous.


The general formula used to estimate the dosage required is:


mEq H+ deficit =

= ((measured HCO3- in mEq/L) - (desired HCO3- in mEq/L)) * (f) * (lean body weight in kg)



• f = fraction of the total body weight in which the administered material is distributed; for HCO3 it is in the range 0.5 - 0.6.


One half of the deficit can be replaced over the first 12 hours and the other half over the next 24 hours.


A solution of 1.0 N HCl diluted in sterile saline is given via a central line at a rate not to exceed 0.2 mEq/kg/hour.


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