Bicarbonate in Severe Lactic Acidosis
Authors: ROMAN JAESCHKE
Journal: Annals of Internal Medicine (1987)

Letters and Corrections1 August 1987Bicarbonate in Severe Lactic AcidosisROMAN JAESCHKE, M.D.ROMAN JAESCHKE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-107-2-258_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The article by Narins and Cohen (1) supporting the use of bicarbonate in severe lactic acidosis provokes several comments. Although no one doubts that there are noxious cardiovascular changes induced by acidemia, this is a dangerous argument for supporting the use of alkali. The evidence suggests that the variables one tries to correct (blood pressure, cardiac output) worsen after infusion of carbon dioxide (2).Relying on arterial pH to show acid-base changes occurring intracellularly can be misleading. Simultaneous measurement of arterial and intracellular pH suggests that infusion of bicarbonate can be associated with paradoxical intracellular acidosis despite...References1. NARINSCOHEN RJ. Bicarbonate therapy for organic acidosis: the case for its continued use. Ann Intern Med. 1987;106:615-7. LinkGoogle Scholar2. ARIEFFLEACHPARKLAZAROWITZ AWRV. Systemic effects of NaHCO3 in experimental lactic acidosis in dogs. Am J Physiol. 1982;242:F586-91. MedlineGoogle Scholar3. PARKLEACHARIEFF RWA. Determination of liver intracellular pH in vivo and its homeostasis in acute acidosis and alkalosis. Am J Physiol. 1979;236:F240-5. MedlineGoogle Scholar4. WEILRACKOWTREVINOGRUNDLERFALKGRIFFEL MERLJM. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med. 1986;315:153-6. CrossrefMedlineGoogle Scholar5. SKOWROWGOLDBERGSULJAGA-PETCHEL MEK. Factors predicting survival for six months after cardiopulmonary resuscitation: multivariate analysis of a prospective study. Mt Sinai J Med (NY). 1985;52:271-5. MedlineGoogle Scholar1. NARINSCOHEN RJ. Bicarbonate therapy for organic acidosis: the case for its continued use. Ann Intern Med. 1987;106:615-8. LinkGoogle Scholar2. MITCHELLWILDENTHALJOHNSON JKR. The effects of acid-base disturbances on cardiovascular and pulmonary function. Kidney Int. 1972;1:375-89. CrossrefMedlineGoogle Scholar3. MORRISMURPHYKITABCHI LMA. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986;105:836-40. LinkGoogle Scholar4. HALECRASENATTRASS PJM. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J. 1984;289:1035-8. CrossrefMedlineGoogle Scholar5. CLANCYCINGOLANITAYLORGRAHAMGILMORE RHRTJ. Influence of sodium bicarbonate on myocardial performance. Am J Physiol. 1967;212:917-23. CrossrefMedlineGoogle Scholar6. GRAFLEACHARIEFF HWA. Evidence for a detrimental effect of bicarbonate therapy in hypoxic lactic acidosis. Science. 1985;227:754-6. CrossrefMedlineGoogle Scholar7. BUREAUBEGINBERTHIAUMESHAPCOTTKHOURYGAGNON MRYDKN. Cerebral hypoxia from bicarbonate infusion in diabetic acidosis. J Pediatr. 1980;96:968-73. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ROMAN JAESCHKE, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byBicarbonate Therapy in Severe AcidosisROBERT G. NARINS, M.D., JORDAN J. COHEN, M.D. 1 August 1987Volume 107, Issue 2Page: 258-259KeywordsBicarbonatesBlood pressureCarbon dioxideCardiac outputLactic acidosis ePublished: 1 December 2008 Issue Published: 1 August 1987 PDF downloadLoading ...