Metabolic Alkalosis

  • 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.


  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