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Home > Dilution > Hydrochloric Acid (hcl)
HYDROCHLORIC ACID (HCL) | ||||||
Usual Diluents | ||||||
D5W, NS | ||||||
Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate] | ||||||
Preparation of 0.1 N solution [100 ml (100 meq ) of 1.0N HCL] [1000 ml] [Infusion rate: see bottom section] Filter HCL with 0.22 micron filter before adding it to the IV bag . Alternatively (Using 37% HCL stock bottle): Preparation of 0.15 N solution -This agent must be infused in glass or polyolefin container. Dosing: Calculations: Stock bottle of 37% HCL. HCL - 37% v/v. Specific gravity: 1.19 g/ml HCL Molecular weight = 36.5 ==================== M1V1 = M2V2 x = (0.1) (1000) / 12 Therefore add 8.3 ml of 37% HCL to 1 liter of D5W or NS to create a 0.1N HCL solution. ---OR ---(Alternative calculation) 12M (37% HCL) = 12 moles/L = 12 x 36.5 = 438 g/L = 438 mg/ml. 3650 mg / 438 mg = 8.33 ml* | ||||||
Stability / Miscellaneous | ||||||
Stability/storage: 24 hr (RT) Indication: treatment of severe or refractory metabolic alkalosis. IV HCl may be indicated in severe metabolic alkalosis (pH >7.55) or when NaCl or KCl cannot be administered because of volume overload or advanced renal failure. May also be indicated if rapid correction of severe metabolic alkalosis is warranted (eg, cardiac arrhythmia or hepatic encephalopathy.)
Definitions: Source: DRUGDEX®: Storage and Stability: HYDROCHLORIC ACID (0.1N) is stable and compatible in VIAFLEX(R) PLASTIC CONTAINERS over a 24 hour storage period (Pers Comm, 1987). Most studies recommend a 0.1 to 0.15 Normal hydrochloric acid solution prepared in sterile water, 5% dextrose in water or normal saline (Wagner et al, 1980g; Williams & Lyons, 1980g). One group of clinicians prepared a 0.1 Normal hydrochloric acid solution by drawing 100 milliequivalents of concentrated hydrochloric acid into a syringe and filtering it through a disposable 0.22 micron filter as it was added to a liter of 5% dextrose in water or normal saline (Wagner et al, 1980g). Others prepared a 0.15 Normal hydrochloric acid solution by diluting 12.5 milliliters of concentrated hydrochloric acid (35% to 38%) to a total volume of 1 liter with sterile water (Williams & Lyons, 1980g). INTRAVENOUS RATE OF ADMINISTRATION: The rate of infusion was 100 to 125 milliliters/hour of a 0.15 Normal hydrochloric acid solution in sterile water (Williams & Lyons, 1980g). One group of practitioners infuses a liter of 0.1 Normal hydrochloric acid in 5% dextrose and water or normal saline over 4 to 6 hours (Wagner et al, 1980g). Some clinicians have corrected severe metabolic alkalosis with prolonged infusion of hydrochloric acid (over a period of 17 days), administering 100 to 400 milliequivalents hydrochloric acid daily through a central venous catheter as 0.1 Normal hydrochloric acid (Reisman & Puri, 1982f). The amount of hydrochloric acid (HCL) administered is based upon base excess (milliequivalent/liter), with an equivalent amount being administered. One report recommends the following formula (Wagner et al, 1980g): HCL (mEq) = Weight (kilogram) x 0.3 X base excess (mEq/liter). The amount of hydrochloric acid administered to each of the 21 patients treated was based upon 1 of 3 equations: Bicarbonate Excess = (0.5 X Weight in kg) X (serum bicarbonate -24); OR Chloride Deficit = (0.2 X Weight in kg) X (103- serum chloride); OR Base Excess = (0.3 X Weight in kg) X (measured base excess). The pH of amino acid solutions containing added hydrochloric acid was significantly higher than that observed with hydrochloric acid added to normal saline. The addition of 100 milliequivalent/liter hydrochloric acid to normal saline produced a pH of approximately 1.5, whereas, addition of the same amount to a 3.5%, 5.5%, and 8.5% amino acid solution increased the pH to approximately 3, 4.5, and 5, respectively. The infusion generally continues until the total base excess is between 0 and 50 milliequivalent (Williams & Lyons, 1980g). Source: UpToDate®: Source: Merck Manual: https://www.merck.com/mmpe/sec12/ch157/ch157d.html Metabolic Alkalosis: Patients with Cl-responsive metabolic alkalosis are given 0.9% saline solution IV; infusion rate is typically 50 to 100 mL/h greater than urinary and other sensible and insensible fluid losses until urinary Cl rises to > 25 mEq/L and urinary pH normalizes after an initial rise from bicarbonaturia. Patients with Cl-unresponsive metabolic alkalosis rarely benefit from rehydration. Patients with severe metabolic alkalosis (eg, pH > 7.6) sometimes require more urgent correction of serum pH. Hemofiltration or hemodialysis is an option, particularly if volume overload is present. Acetazolamide 250 to 375 mg po or IV once/day or bid increases HCO3 − excretion but may also accelerate urinary losses of K+ and PO4 −; volume-overloaded patients with diuretic-induced metabolic alkalosis and those with posthypercapnic metabolic alkalosis may especially benefit. Hydrochloric acid in a 0.1 to 0.2 normal solution IV is safe and effective but must be given through a central catheter because it is hyperosmotic and scleroses peripheral veins. Dose is 0.1 to 0.2 mmol/kg/h, with frequent monitoring of ABG and electrolytes.
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