FACTORS GOVERNING CORRECTION OF THE ALKALOSIS ASSOCIATED WITH POTASSIUM DEFICIENCY; THE CRITICAL ROLE OF CHLORIDE IN THE RECOVERY PROCESS*

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Abstract
Balance studies have been carried out on six dogs in order to assess the factors governing correction of the metabolic alkalosis associated with K deficiency. Alkalosis and hypochloremia were induced by the administration of DOCA, sodium bicarbonate, and a diet of low K and Cl content; there was an average increase of 17 mEq/l in plasma bicarbonate concentration accompanied by a virtually equal reduction in plasma chloride concentration. Withdrawal of DOCA was followed by an average fall of 2 mEq/l in plasma bicarbonate concentration. Administration of K bicarbonate in place of Na bicarbonate produced a further average fall of only 5 mEq/l in plasma bicarbonate concentration despite almost complete repair of the K deficit. Thus, mean plasma bicarbonate concentration was still 10 mEq above control levels after equilibrium between K intake and excretion had been established. The subsequent administration of Cl as either NaCl, K Cl, or by substitution of Cl for P was accompanied by a prompt reduction in plasma bicarbonate concentration to control levels. In each dog there was an increase in net alkali excretion as Cl was retained. These data, taken together with the previous observations on the recovery from chronic respiratory acidosis, suggest that under a variety of circumstances Cl plays a critical role in the regulation of acid-base equilibrium. An hypothesis which may account for the influence of Cl on the transtubular movement of H ions into the glomerular filtrate has been considered.