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To the Editor:—
Readers may get the wrong impression from Dr. Plum's letter. The primary approach is to improve the airways and increase alveolar ventilation.A very low arterial blood pH is incompatible with life if allowed to persist; hence it is desirable to elevate the pH out of the low critical range as rapidly as possible. In such cases sodium bicarbonate can be added to a continuous intravenous drip, using at least 10 to 20 gm of sodium bicarbonate in a liter of fluid. Arterial blood pH should be used to monitor the amount of bicarbonate administered, since it is possible to overshoot the normal pH range and produce a significant alkalosis. I have been using this procedure for over 15 years with no adverse effects. Procedures to increase the alveolar ventilation are instituted as rapidly as possible once the diagnosis is made. When the initial pH is below
Motley HL. Sodium Bicarbonate in Respiratory Acidosis. JAMA. 1964;189(3):243. doi:10.1001/jama.1964.03070030065036