Metabolic Alkalosis

1. If patient is receiving diuretic therapy, consider temporarily discontinuing diuretics.

2. Chloride-resistant alkalosis can be treated with a carbonic anhydrase inhibitor (acetazolamide), which blocks proximal tubule reabsorption of HCO3.

3. Treatment with HCl or ammonium chloride can be considered if alkalosis is severe (pH > 7.55) despite volume replacement or in cases with cardiac arrhythmias. Calculate H+ ion deficit as follows:

x (Measured HCO3 - Desired HCO3 [mEq/L])

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