Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. a prospective, multiple-center study

Importance of Metabolic Acidemia

Viktor Rosival   (2012-01-03 11:20)  D��rer's Hospital

In the recent study of Jung et al [l] there are some discrepancies with the literature.

In the paragraph ��Discussion��, the authors write also ��Whether metabolic acidemia is an etiologic contributor to organ dysfunction, or rather just a marker of illness has been debated��. Several papers have reported negative influence of low blood pH on the level of consciousness; recently, these findings have been confirmed by Nyenwe et al [2]. The glycolytic enzyme phosphofructokinase is pH dependent, as its activity is decreasing with decreasing pH [3]. Therefore, brain cells cannot utilise glucose [4]. Where are published papers denying these results?

In the last sentence of their paper, the authors write ��In 2011, there is no human study that has reported any beneficial or detrimental effect of sodium bicarbonate administration when facing severe mixed or metabolic acidemia ... .�� Several papers have reported zero lethality of diabetic ketoacidotic coma if the treatment included infusions of alkalising solutions, e g [5]. Without alkalising solutions, lethality is up to 100%, e g [6]. Perhaps the decrease of lethality from 100% to zero% is a ��beneficial effect��?

Dr. Viktor Rosival, PhD,
SYNLAB department of laboratory medicine, D��rer's Hospital,
Limbov�� 5
SK-833 05 Bratislava,
Slovakia.
e-mail: rosivalv@hotmail.com

References

1. Jung B, Rimmele Th, Le Goff Ch, Chanques G, Corne Ph, Jonquet 0, Mailer L, Lefran J-Y, Guervilly Ch, Papazian L et al: Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and impact of buffer therapy: a prospective, multiple-center study. Crit Care 2011, 15:R238
2. Nyenwe EA, Khan AE, Razavi LN, Wan JY, Kitabchi AE: Acidosis: The Prime Determinant of Depressed Sensorium in Diabetic Ketoacidosis. Diabetes Care 2010, 33:1837-1839
3. Trivedi B, Danforth WH: Effect of pH on the Kinetics of Frog Muscle Phosphofructokinase. J biol Chem 1966, 241:4110-4112.
4. Van Nimmen D, Weyne J,. Demeester G, Leusen I: Local cerebral glucose utilization in systemic acidosis. Am J Physiol 1984, 247:R639-R645.
5. Wagner A, Risse: A, Brill H-L, Wienhausen-Wilke V, Rottmann M, Sondern K, Angelkort B: Therapy of Severe Diabetic Ketoacidosis. Diabetes Care 1999, 22:674-677.
6. Basu A, Close CF, Jenkins D, Krentz AJ, Nattrass M, Wright AD: Persisting mortality in diabetic ketoacidosis. Diabet Med 1993, 10:282-284.

Competing interests

I have no competing interests.

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