Loss of bicarbonate in diarrhea is probably the most common underlying factor. Administration of excessive amounts of exogenous acids during IV infusion of hydrochloric acid or total parenteral nutrition is an occasional cause. Renal tubular acidosis can also cause renal loss of bicarbonate. Hyperchloremic acidosis is diagnosed on the basis of history, physical examination, and laboratory studies. Typically, there is a low-grade acidosis with low bicarbonate and a normal anion gap.
Treatment usually aims at the underlying cause.
Treatment of diarrhea resolves the acidosis in the first case. Most patients with renal tubular acidosis will require maintenance bicarbonate therapy. In exogenous causes - interruption of acid administration is usually sufficient treatment. M. An analytical approach to diagnosing acid-base disorders. Parillo J, Bone R. Critical Care Medicine - Principle of Diagnosis and Management.