Alkali therapy in patients with metabolic acidosis.

To the Editor: In his review "Acid-Base Disorders in lCU Patients, Oh1) writes in the summary on p 66 "The treatment target ... is not the acidosis, but the underlying condition causing acidosis". In contrast to this statement, Edge et al.2) have concluded that the immediate cause of coma in patients with acidosis is the very low blood pH. The glycolytic enzyme phosphofructokinase is pH dependent, as its activity is decreasing with decreasing pH, and, thus, glucose utilization in brain cells is impaired3). For the readers of "Electrolyte Blood Press" it would be perhaps interesting to know, why the author did not comment the paper of Edge et al.2).

On p 69, the author writes "HCO3- therapy does not improve the outcome in diabetic ketoacidosis ..." Life-threatening is the most severe stage of diabetic ketoacidosis, coma. If the treatment of diabetic ketoacidotic coma included also infusions of alkalizing solutions, lethality was zero %, e g4). Without alkalizing solutions, lethality was up to 100%, e g5). Again, it would be perhaps interesting to know why the author did not comment the papers of Wagner et al.4) and Basu et al.5).