Metabolic alkalosis due to plasmapheresis.

Progressive metabolic alkalosis developed in two patients undergoing daily plasmapheresis for diffuse intrapulmonary hemorrhage associated with glomerulonephritis (Goodpasture's-like syndrome). The metabolic alkalosis promptly resolved when the plasmapheresis procedure was altered so that 3 percent albumin and cryoprecipitate rather than fresh frozen plasma were used as replacement for the removed patient plasma. The development of metabolic alkalosis during plasmapheresis can be explained by the large sodium citrate load given during the procedure. Severe metabolic alkalosis may develop in patients with decreased renal function when they are treated with plasmapheresis. The metabolic alkalosis can be prevented by appropriate modifications in the plasmapheresis protocol.