Metabolic alkalosis has many consequences, notably arrhythmias, seizures, respiratory depression and oxygen transport problems. It occurs in various settings which include chronic hypercapnea, liver transplantation, and dehydration. When emergent correction is needed it can be treated with carbonic anhydrase inhibiting diuretics or acid infusion (which works much more quickly). Hydrochloric acid can be used but causes peripheral vein sclerosis, thus requiring use of a central vein catheter. Ammonium chloride is also used but can cause ammonia toxicity. Arginine monohydrochloride is not venosclerotic and contains no ammonia. It is commonly used to treat metabolic alkalosis, but no literature exists regarding its safety or efficacy. This report is presented to provide such informarion.
Design: Retrospective review of the charts of all patients treated for metabolic alkalosis with arginine monochloride in this hospital during a two year period. The standard regimen was a single dose of 60 gm. arginine monohydrochloride in 600 ml. diluent administered intravenously over 10 hours with blood chemistries and ABGs performed before and after administration. Each patient's chart was evaluated for teatment complications. Blood chemistry and ABG values from before treatment were compared with those from after treatment using Student's T test for paired data.
24 patients (9 women and 15 men) were treated with arginine monohydrochloride during the period reviewed. Their mean age was 67 ± 15 years. They suffered from COPD, cancer, sleep apnea, interstitial lung disease, muscle disease and drug intoxication. After treatment, all showed statistically significant decreases in bicarbonate concentration (the mean decrease was 12 ± 4 ≥) and CO2 partial pressure (the mean decrease was 23 ± 6.2 torr) with a concurrent significant increase of 9 ± 5 ≥ in the mean chloride concentration. There was no change in pH or BUN and there were no complications of therapy.
Arginine monohydrochloride is safe, easy to use and effective in the correction of metabolic alkalosis.
Arginine monohydrochloride should be considered a first line medication in the treatment of patients with metabolic alkalosis.
William Marino, No Financial Disclosure Information; No Product/Research Disclosure Information