Metabolic alkalosis is fairly common among hospitalized patients. The most severe cases are often due to large-volume diuresis (deresuscitation), massive transfusion, or ongoing nasogastric suction. Many patients will respond to simple resuscitation with normal saline (an acidotic fluid which is perfect here). However, more severe or complex cases will require a multi-modal strategy which utilizes several therapies simultaneously. And when all else fails, there's always hydrochloric acid.
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Josh is the creator of PulmCrit.org. He is an associate professor of Pulmonary and Critical Care Medicine at the University of Vermont.
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