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Significant hypokalemic metabolic alkalosis has been found to occur in some patients with cirrhosis.
Although respiratory alkalosis has been previously noted in patients in hepatic coma, metabolic alkalosis associated with cirrhosis apparently has not been previously described, according to Richard D. Sloop, MD.
In an approach to therapy which they acknowledged to be unorthodox, Dr. Sloop and his co-worker, Marshall J. Orloff, MD, University of California School of Medicine, Los Angeles, used parenteral administration of substantial amounts of ammonium chloride, as well as potassium chloride, to correct the metabolic alkalosis which they described.Although ammonia has been implicated as a cause of hepatic coma, the acidifying properties of ammonium chloride in these patients uniformly counteracted any potentially neurotoxic properties of the ammonium ion, Dr. Sloop said."It must be emphasized, however, that this cancelling-out effect might not be obtained in patients who are not alkalotic," he said.
Metabolic Alkalosis And Cirrhosis. JAMA. 1966;198(5):38. doi:10.1001/jama.1966.03110180018006