The Scientific World Journal
Volume 2015 (2015), Article ID 897517, 2 pages
http://dx.doi.org/10.1155/2015/897517

Letter to the Editor

Comment on “Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis”

Viktor Rosival

SYNLAB Department of Laboratory Medicine, Dérer’s Hospital, Limbová 5, 833 05 Bratislava, Slovakia

Received 11 May 2015; Accepted 19 May 2015

Academic Editor: Biagio R. Di Iorio

Copyright © 2015 Viktor Rosival. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

In the paper of Adeva-Andany et al. [1] there are some discrepancies with the literature.

(1)The authors write “Evidence that significant harmful effects are derived from metabolic acidosis by itself has not been provided in human beings and therefore the successful management of metabolic acidosis require the therapy of the underlying causative disorder.” According to Edge et al. [2] and Nyenwe et al. [3] metabolic acidosis (= low blood-pH = high concentration of hydrogen ions H₊) is the immediate cause of decreased level of consciousness including coma: the glycolytic enzyme phosphofructokinase is pH-dependent, as its activity is decreasing with decreasing pH. The consequence is impaired utilisation of glucose in brain cells. Where are published papers denying the results of Edge et al. and Nyenwe et al.?(2)The authors write “Both retrospective and prospective studies have consistently documented that sodium bicarbonate therapy does not improve metabolic responses, biochemical parameters, acid-base balance normalisation, or clinical outcomes among patients with DKA, either children or adults.” In diabetic ketoacidosis, life-threatening is only its most severe stage, coma. If the facts presented in paragraph 1 are correct, thus increase of the very low blood-pH in the comatose patient after infusion of alkalising solution (such as sodium bicarbonate) should result in recovery to normal state of consciousness. And this has been reported in reality: lethality of coma in diabetic ketoacidosis is zero with treatment which includes infusions of alkalising solutions, for example, Umpierrez et al. [4]. Without alkalising solutions, lethality of coma in diabetic ketoacidosis is up to 100%, for example, Basu et al. [5]. Where are published reports on zero lethality of coma in diabetic ketoacidosis without infusions of alkalising solutions?

Conflict of Interests

The author declares that there is no conflict of interests regarding the publication of this paper.

References

M. M. Adeva-Andany, C. Fernández-Fernández, D. Mouriño-Bayolo, E. Castro-Quintela, and A. Domínguez-Montero, “Sodium bicarbonate therapy in patients with metabolic acidosis,” The Scientific World Journal, vol. 2014, Article ID 627673, 13 pages, 2014.

J. A. Edge, Y. Roy, A. Bergomi et al., “Conscious level in children with diabetic ketoacidosis is related to severity of acidosis and not to blood glucose concentration,” Pediatric Diabetes, vol. 7, no. 1, pp. 11–15, 2006.

E. A. Nyenwe, A. E. Khan, L. N. Razavi, J. Y. Wan, and A. E. Kitabchi, “Acidosis: the prime determinant of depressed sensorium in diabetic ketoacidosis,” Diabetes Care, vol. 33, no. 8, pp. 1837–1839, 2010.

G. E. Umpierrez, J. P. Kelly, J. E. Navarrete, M. M. Casals, and A. E. Kitabchi, “Hyperglycemic crises in urban blacks,” Archives of Internal Medicine, vol. 157, no. 6, pp. 669–675, 1997.

A. Basu, C. F. Close, D. Jenkins, A. J. Krentz, M. Nattrass, and A. D. Wright, “Persisting mortality in diabetic ketoacidosis,” Diabetic Medicine, vol. 10, no. 3, pp. 282–284, 1993.