Dilution Hydrochloric Acid (hcl) - GlobalRPH

Most studies recommend a 0.1 to 0.15 Normal hydrochloric acid solution prepared in sterile water, 5% dextrose in water or normal saline (Wagner et al, 1980g; Williams & Lyons, 1980g). One group of clinicians prepared a 0.1 Normal hydrochloric acid solution by drawing 100 milliequivalents of concentrated hydrochloric acid into a syringe and filtering it through a disposable 0.22 micron filter as it was added to a liter of 5% dextrose in water or normal saline (Wagner et al, 1980g). Others prepared a 0.15 Normal hydrochloric acid solution by diluting 12.5 milliliters of concentrated hydrochloric acid (35% to 38%) to a total volume of 1 liter with sterile water (Williams & Lyons, 1980g).

INTRAVENOUS RATE OF ADMINISTRATION: The rate of infusion was 100 to 125 milliliters/hour of a 0.15 Normal hydrochloric acid solution in sterile water (Williams & Lyons, 1980g). One group of practitioners infuses a liter of 0.1 Normal hydrochloric acid in 5% dextrose and water or normal saline over 4 to 6 hours (Wagner et al, 1980g). Some clinicians have corrected severe metabolic alkalosis with prolonged infusion of hydrochloric acid (over a period of 17 days), administering 100 to 400 milliequivalents hydrochloric acid daily through a central venous catheter as 0.1 Normal hydrochloric acid (Reisman & Puri, 1982f).

The amount of hydrochloric acid (HCL) administered is based upon base excess (milliequivalent/liter), with an equivalent amount being administered. One report recommends the following formula (Wagner et al, 1980g): HCL (mEq) = Weight (kilogram) x 0.3 X base excess (mEq/liter).

The amount of hydrochloric acid administered to each of the 21 patients treated was based upon 1 of 3 equations: Bicarbonate Excess = (0.5 X Weight in kg) X (serum bicarbonate -24); OR Chloride Deficit = (0.2 X Weight in kg) X (103- serum chloride); OR Base Excess = (0.3 X Weight in kg) X (measured base excess). The pH of amino acid solutions containing added hydrochloric acid was significantly higher than that observed with hydrochloric acid added to normal saline. The addition of 100 milliequivalent/liter hydrochloric acid to normal saline produced a pH of approximately 1.5, whereas, addition of the same amount to a 3.5%, 5.5%, and 8.5% amino acid solution increased the pH to approximately 3, 4.5, and 5, respectively.

The infusion generally continues until the total base excess is between 0 and 50 milliequivalent (Williams & Lyons, 1980g).