Treatment of gastrointestinal causes of hyperchloremic acidosis targets the underlying cause and reverts the administration of saline and early administration of potassium. Treatment of acidosis with bicarbonate solutions is accompanied by potassium supplementation to avoid severe hypokalemia with possible cardiac arrhythmias and muscle paralysis due to the rapid introduction of potassium into cells. She has hyperchloric acidosis due to diarrhea with a chloride concentration of 115 mEq/L, a bicarbonate concentration of 15 mEq/L her, and a normal anion gap. Should I use isotonic bicarbonate during volume therapy to correct her hyperchloric acidosis? Will correcting her hyperchloric acidosis actually help her or just improve her levels? However, this controversy focuses primarily on the use of bicarbonate to treat lactic acidosis or ketoacidosis. , should reverse the progression of the underlying disease. The situation is different in hyperchloremic metabolic acidosis. The main problem is bicarbonate deficiency, whether due to bicarbonate depletion or volume replenishment with saline. However, physicians are often reluctant to treat hyperchloremic metabolic acidosis with bicarbonate. This post attempts to clarify the reasons for treatment. Balanced crystalloids are becoming more and more popular, but there is nothing great about these liquids by themselves. is avoidance. Therefore, rather than viewing these studies as "normal saline and balanced crystalloids", it may be more accurate to view them as "volume expansions with or without the production of hyperchloric acidosis". From this perspective, it is clear that hyperchloremic acidosis is not benign. Hyperchloric acidosis causes compensatory respiratory alkalosis and increases the work of breathing. In most cases, this is not very important, but it may be undesirable for patients with shock or respiratory failure. Experiments comparing normal saline with balanced crystalloids have shown that hyperchloremic acidosis impairs blood flow and renal function. This is probably due to vasoconstriction of afferent renal arterioles in response to hyperchloremia. Although this is indirect evidence, it suggests that correcting hyperchloremic acidosis benefits patients and is not just a numerical correction. Often achieved with intravenous isotonic bicarbonate (150 mEq/L), which may require substantial volumes. Correction of hyperchloric acidosis during fluid-guided resuscitation is reasonable because judicious use of isotonic bicarbonate in fluid-depleted patients is associated with lower risk (pH-guided resuscitation). as explained in a previous article on resuscitation). The value of isotonic bicarbonate in normocytic patients is unknown, but may be helpful if the patient has impaired renal function. In patients with hypervolemia, dehydration with loop diuretics improves both hydration status and bicarbonate levels simultaneously. Therefore, the most important consideration may be avoiding hyperchloric acidosis (i.e., achieving 'euchloremia') rather than the exact fluids used for resuscitation. For example, if a patient has hyperchloric acidosis prior to resuscitation, it is better to correct it with isotonic bicarbonate (an "unbalanced" fluid) rather than using balanced fluids. There are cases. Ultimately, having a balanced patient is more important than having a balanced IV fluid. Many exogenous causes of hyperchloric acidosis have been described as a logical review. When substances such as ammonium chloride and hydrochloric acid are introduced into the body, they react with bicarbonate to buffer the pH. However, this depletes bicarbonate stores and leads to an overly acidic state. As mentioned earlier, chloride and bicarbonate work together to maintain the ionic balance in the cell space. Hyperchlorhydria forces bicarbonate into cells to maintain ionic balance and reduce available bicarbonate to the pH buffer system, resulting in net acidosis.