Lactic Acidosis and Bicarbonate Therapy

Excerpt

To the editor: Annals has recently published an editorial by Stacpoole (1) opposing the use of bicarbonate for the treatment of lactic acidosis and an argument in rebuttal by Narins and Cohen (2) in support of its use. The arguments used by Narins and Cohen omit certain details.

Narins and Cohen criticize the experimental models of lactic acidosis in that mortalities approached 100%. Although this is true, it should be emphasized that even the acute administration of bicarbonate was associated with deleterious effects. In the phenformin model (3), bicarbonate therapy was associated with decreases in cardiac output, intracellular pH of