MICHAEL D. CLAYMAN
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To the editor: I wish to take issue with a small part of the recent article "Phenformin-Associated Lactic Acidosis: Pathogenesis and Treatment," by Dr. Misbin (Ann Intern Med 87:591-595, 1977). Although the administration of bicarbonate in the setting of metabolic acidosis is known to be associated with a paradoxical CSF acidosis (1, 2), the question of clinical relevance of this phenomenon has never been clearly addressed. In fact, careful reading of two of the articles quoted in the Misbin paper indicates that a paradoxical CSF acidosis occurs with treatment of diabetic ketoacidosis regardless of whether bicarbonate is administered; bicarbonate-induced aggravation
CLAYMAN MD. Treatment of Diabetic Ketoacidosis. Ann Intern Med. 1978;88:580–581. doi: 10.7326/0003-4819-88-4-580_2
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Published: Ann Intern Med. 1978;88(4):580-581.
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