All are useful for treatment of metabolic alkalosis except

Metabolic Alkalosis This is primarily directed at correcting the underlying stimulus for HCO3-generation. If primary aldosteronism or Cushing's syndrome is present, correction of the underlying cause, when successful, will reverse the hypokalemia and alkalosis. loss by the stomach or kidneys can be mitigated by the use of proton pump inhibitors or the discontinuation of diuretics. The second aspect of treatment is to remove the factors that sustain the inappropriate increase in HCO3-reabsorption, such as ECFV contraction or K+deficiency. K+deficits should always be repaired. Isotonic saline is recommended to reverse the alkalosis when ECFV contraction is present. If associated conditions preclude infusion of saline, renal HCO3-loss can be accelerated by administration of acetazolamide, a carbonic anhydrase inhibitor (125-250 mg IV), which is usually effective in patients with adequate renal function but can worsen K+losses. Dilute hydrochloric acid (0.1NHCl) has been advocated historically in extreme cases, but can cause hemolysis, and must be delivered slowly in a central vein. This preparation is not available generally and must be mixed by the pharmacist. Because serious errors or harm may occur, its use is not recommended. * Ammonium chloride is used and not hydroxide . Ammonium chloride is a systemic and urinary acidifying agent that is conveed to ammonia and hydrochloric acid through oxidation by the liver.