• The most common cause is the loss of hydrochloric acid as a result of vomiting or nasogastric suction¹
• Less common causes:
  • Technical errors during HD
  • Malfunction of the dialysis machine’s pH monitor and proportioning system (the reversed connection of bicarbonate and acid concentrate containers to the entry ports²)
• Severe metabolic alkalosis may cause:
  • Tissue hypoxia
  • Arrhythmia
  • Seizure
  • Delirium
  • Stupor
• Applying HD therapy with specially formulated low-bicarbonate, low-acetate, or acid dialyses are safe and effective intervention for severe metabolic alkalosis³.  Severe metabolic alkalosis can be corrected rapidly and safely with bicarbonate concentrates dialysate between 25-28 mEq/L⁴.

References:

1. Gennari FJ, Rimmer JM. Acid-base disorders in end-stage renal disease: Part II. Semin Dial 3:161-165, 1990
2. Sethi D, Curtis JR, Topham DL, Gower PE. Acute metabolic alkalosis during haemodialysis. Nephron 51:119-120, 1989
3. Leblanc M, Farah A. Severe metabolic alkalosis corrected by hemodialysis. Clin Nephrol 48:65, 1997
4. Hsu SC, Wang MC, Liu HL, Tsai MC, Huang JJ. Extreme metabolic alkalosis treated with normal bicarbonate hemodialysis. Am J Kidney Dis 37:E31, 2007