The authors reply: alkali therapy in patients with metabolic acidosis.

The Authors Reply: Severe metabolic acidosis can generate detremental clinical effect such as cardiovascular depression and central nervous system dysfunction1). It also disturbe important key enzymes' activity2). The effect of bocarbonate therapy aimed at correcting the pH, however, is controversial. Bicarbonate therapy produced CO2 and paradoxically lower the intracellular pH and cerebrospinal fluid pH3, 4). Bicarbonate infusion is associated with an increased blood lactate levels4). It might be also produce the volume expansion, hypernatremia and renbound alkalemia. The other buffer agents such as Carbicarb (Na2CO3 + NaHCO3) and THAM (Tris-hydroxymethyl aminomethane) are available, but these agents dose not imporving outcomes of metabolic acidosis4).

Therefore, recent articles and text books suggest that therapy is aimed at correction of the underlying disorder, volume depletion, and electrolyte imbalance4-6). On condition that severe acidosis (pH < 7.1) and the patient is deteriorating rapidly, bicarbonate therapy can be considered.