Acid load during total parenteral nutrition: comparison of hydrochloric acid and acetic acid on plasma acid-base balance

The effects of hydrochloric acid and acetic acid on the plasma acid-base balance were investigated in four rabbits receiving parenteral nutrition. Hyperchloremic metabolic acidosis was observed only in the animals receiving total parenteral nutrition (TPN) whose pH was adjusted with hydrochloric acid. The observed acidosis was due to an excess of hydrogen ions with chloride ions as judged by the plasma-base excess and urinary net-acid excess and not by the infusion of solution having a high titratable acidity. The hydrogen ion released from the acetic acid added to TPN is consumed by the metabolism of the acetate ion and thus does not contribute to the net hydrogen-ion load. A reduction in the chloride load by using acetic acid to adjust the pH of the TPN solution when it is formulated can be safely achieved and prevents acidosis.