JOHN S. RODMAN, M.D.
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To the editor: The fall in plasma bicarbonate and pH observed by Fraley and associates (1) in a patient, with short bowel syndrome and prolonged starvation, who received hyperalimentation is interesting. The inability of the kidney to correct the acidosis was ascribed to a failure to generate titratable acidity.
The patient had a serum phosphorus of 2 mg/dl. Hyperalimentation, even in the presence of renal failure, will augment cellular uptake of phosphate. It is not unusual to have to give supplemental phosphate to such patients even if they are severely oliguric (2). Titratable acid is composed largely of dihydrogen phosphate
RODMAN JS. Phosphate Depletion and Acidosis. Ann Intern Med. ;89:148. doi: 10.7326/0003-4819-89-1-148_1
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Published: Ann Intern Med. 1978;89(1):148.
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