Management

1. Replacement of fluid, sodium, chloride (i.e. give 0.9% saline) and potassium losses are often sufficient to restore acid-base balance.

2. With distal renal causes related to hyperaldosteronism, addition of spironolactone (or potassium canrenoate) can be considered.

3. Active treatment is rarely necessary. If so, give ammonium chloride 5 g tds PO. Hydrochloric acid has been used on occasion for severe metabolic alkalosis (pH >7.7). It should be given via a central vein in a concentration of 1 mmol HCl per ml water at a rate not exceeding 1 mmol/kg/h.

4. Compensation for a long-standing respiratory acidosis, followed by correction of that acidosis, e.g. with mechanical ventilation, will lead to an uncompensated metabolic alkalosis. This usually corrects with time though treatments such as acetazolamide can be considered. Mechanical 'hypoventilation', i.e. maintaining hypercapnia, can also be considered.

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