Use of Bicarbonate and K in Metabolic Acidosis

Abstract

To the Editor: The authors of two recent articles on metabolic acidosis in the Journal ^{1 , 2} appropriately point out the several dangers of bicarbonate therapy, but nevertheless strongly advocate its use. Of course in disorders such as renal tubular acidosis, bicarbonate administration is usually necessary since the underlying defect cannot be readily corrected. However, in disorders such as diabetic ketoacidosis or short-lived diarrheal states, if the excessive acid production (or base loss) is terminated and the buffer stores are being repleted (by the kidney), the need for exogenous base is less obvious. Under the circumstance of severe acidosis (plasma bicarbonate less . . .