The total body Cl - should be repleted by giving 25 percent of the calculated Cl- deficit as KCl and 75 percent as NaCl. In the setting of renal insufficiency or failure, treatment options are more complicated in that NaCl administration may lead to volume problems and KCl may lead to hyperkalemia. The replacement method of choice, amino acid hydrochlorides or 0.1 N HCl, will lead to a non-anion-gap acidosis, worsening the underlying wide-anion-gap acidosis associated with renal failure.
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