A patient with hypochloremic metabolic alkalosis may rarely require correction of the alkalosis by intravenous infusion of a dilute hydrochloric acid solution.


Patient selection:

(1) The patient should have hypochloremic metabolic alkalosis.

(2) There has been an insufficient response to sodium chloride, potassium chloride or drug therapy, or these are contraindication for using these in the patient.

(3) There is a need for rapid correction.



(1) body weight in kilograms

(2) measured serum chloride in mmol/L


dose of HCl in mmol =

= 0.2 * (body weight in kilograms) * (103 - (measured serum chloride in mmol/L))



• 0.2 * (body weight in kilograms) represents the estimated chloride space.

• The formula weight of hydrochloric acid is 36.46 grams.


Preparation of solution: 1 N HCl is passed through a 0.22 micron filter and diluted using normal saline or 5% glucose with either:

(1) 1 in 5 (1 to 4 proportion) for a 0.2 N solution (0.2 mEq/mL), or

(2) 1 in 10 (1 to 9 proportion) for a 0.1 N solution (0.1 mEq/mL) .

The infusion is given through a central venous catheter to minimize the risk of extravasation.


The infusion is given at a rate of 10-12.5 mEq per hour (10-12.5 mL per hour of the 0.1 N solution or 5 - 6.25 mL of the 0.2 N solution). Because of the low volumes an infusion pump should be considered. Correction usually takes place in 6-24 hours.


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