A drug used to treat severe metabolic alkalosis after other treatments have failed is:

• A. Divided
• B. Kept the same
• C. Reduced
• D. Arginine

Answer: (D)

Metabolic alkalosis is best corrected by reintroducing a chloride source and providing a modest acid load so the kidneys can excrete the excess bicarbonate. When standard measures aren’t enough, using an acidifying, chloride-containing agent can be effective. Arginine, especially as arginine hydrochloride, supplies chloride and delivers a small acid load as it is metabolized. This helps restore chloride balance and shifts the kidneys toward bicarbonate excretion, lowering the elevated bicarbonate level and correcting the alkalosis. Monitor electrolytes (particularly potassium and chloride) and be mindful of fluid and sodium balance during this approach. The other options do not describe a pharmacologic intervention that provides chloride or acid loading to correct the acid-base disturbance.