Treatment of Acidosis or Alkalosis
The best treatment for acidosis or alkalosis is to correct the condition that caused the abnormality. This is often difficult, especially in chronic diseases that cause impaired lung function or kidney failure. In these cir-cumstances, various agents can be used to neutralize the excess acid or base in the extracellular fluid.
To neutralize excess acid, large amounts of sodiumbicarbonate can be ingested by mouth. The sodiumbicarbonate is absorbed from the gastrointestinal tract into the blood and increases the bicarbonate portion of the bicarbonate buffer system, thereby increasing pH toward normal. Sodium bicarbonate can also be infused intravenously, but because of the potentially dangerous physiologic effects of such treatment, other substances are often used instead, such as sodium lactate and sodium gluconate. The lactate and gluconate portions ofthe molecules are metabolized in the body, leaving the sodium in the extracellular fluid in the form of sodium bicarbonate and thereby increasing the pH of the fluid toward normal.
For the treatment of alkalosis, ammonium chloride can be administered by mouth. When the ammonium chloride is absorbed into the blood, the ammonia portion is converted by the liver into urea. This reaction liberates HCl, which immediately reacts with the buffers of the body fluids to shift the H+ concentra-tion in the acidic direction. Ammonium chloride occasionally is infused intravenously, but NH4+ is highly toxic, and this procedure can be dan-gerous. Another substance used occasionally is lysinemonohydrochloride.