ROBERT G. NARINS, M.D.; JORDAN J. COHEN, M.D.
To the editor: We wish to address recent objections (1, 2) raised to our advocacy of bicarbonate therapy in severe organic acidosis. The salutary effect of infused alkali may be offset by two countervailing forces. Untreated lactic acid overproduction may prevent correction of hypobicarbonatemia while titration of infused alkali generates CO2 causing local or systemic hypercapnia. Failure to control these issues has rendered animal models of lactic acidosis poorly reflective of the human condition (3). Fixed ventilation in experimental animals artificially impairs their removal of additional CO2, thereby sustaining relative or absolute hypercapnia while their acidosis is allowed to continue
ROBERT G. NARINS, JORDAN J. COHEN. Bicarbonate Therapy in Severe Acidosis. Ann Intern Med. 1988;108:311. doi: 10.7326/0003-4819-108-2-311_2
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Published: Ann Intern Med. 1988;108(2):311.
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