Metabolic alkalosis induced by regional citrate hemodialysis.

Two patients are described in whom regional citrate dialysis (RCD) and induced metabolic alkalosis with marked increases in serum HCO3, which were sustained during the period of repeated treatments. As currently employed, RCD of necessity delivers large amounts of potential bicarbonate (several hundred mEq) to the patient and may cause severe metabolic alkalosis. Studies should be carried out to determine an effective method to avoid this complication whenever repeated RCD is necessary or is used in patients with pre-existing alkalosis.