Treatment for metabolic acidosis

Optimal treatment for non–anion gap (hyperchloraemic) metabolic acidosis depends on serum sodium concentration and volume status. Resuscitation with an intravenous crystalloid solution re-equilibrates acid-base status and is usually sufficient treatment. Mild to moderate acidosis may persist for 3 days, but usually resolves.

Intravenous sodium bicarbonate therapy is seldom required and only considered if metabolic acidosis is severe or resistant. Seek advice from a clinical toxicologist.

Consider haemodialysis after topiramate poisoning in patients who have kidney failure or severe metabolic acidosis. Seek advice from a clinical toxicologist. For more information on haemodialysis, see here.