Metabolic Acidosis Resulting from Intravenous Alimentation Mixtures Containing Synthetic Amino Acids

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Abstract
Hyperchloremic metabolic acidosis was observed in 11 infants receiving total parenteral nutrition containing mixtures of synthetic L-amino acids. The observed acidosis was not due to excessive gastrointestinal or renal losses of base as judged by the stool undetermined anion content and the urinary net acid excretion, nor was it due to infusion of preformed hydrogen ion as judged by the titratable acidity of the synthetic amino acid mixtures. Instead, the synthetic amino acid mixtures contain an excess of cationic amino acids in relation to anionic amino acids or other organic anions. Metabolism of these cationic amino acids results in a net excess of hydrogen ion, explaining the observed acidosis.