Sodium Bicarbonate Is Beneficial in Patients With Diabetic Ketoacidosis

Abstract

To the Editor.—In their recent review,1 Aschner and Poland wrote that “clinicians should resist the common impulse to administer bicarbonate to infants with metabolic acidosis… . Instead, they should concentrate their efforts on understanding and treating the underlying cause of the acidosis.”1(p835) However, in the “ ′Basic' Facts on Use for Neonatal Metabolic Acidosis” section,1(p833) they did not discuss the question of whether metabolic acidosis (ie, low blood pH) is dangerous.According to Edge et al,2 very low blood pH is the cause of coma: the glycolytic enzyme phosphofructokinase is pH dependent,3 as its activity is decreasing with decreasing pH; thus, glucose use in brain cells is impaired. Therefore, the clinical consequences of decreasing blood pH are drowsiness, stupor, coma, and death in coma.The authors also wrote, “Metabolic acidosis is a common finding in NICUs,”1(p833) probably also with very low blood pH (<7.00). It would be interesting to know what the outcome was of newborn infants with such a low blood pH with and without bicarbonate therapy.