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December 15, 1975

Recovery From Severe Metabolic Acidosis

JAMA. 1975;234(11):1119. doi:10.1001/jama.1975.03260240023014

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To the Editor.—  Recently, a 24-year-old woman was admitted to our emergency ward in profound metabolic acidosis. This was associated with tonic seizures that ultimately proved to be a result of pure strychnine poisoning. The initial pH was 6.57 (checked and rechecked); Po2,140 mm Hg; and Pco2, 18 mm Hg. Blood lactate level was 177 mg/100 ml (normal, 0 to 16). Subsequent pH values were 6.70, 6.95, 7.15, and 7.37, giving sodium bicarbonate; ultimately, 35 ampules (each containing 50 ml of 50 mEq sodium bicarbonate 8.4%) were administered intravenously over a 90-minute period. The patient was discharged four days later without sequelae.I have been unable to find reports of this degree of acidosis associated with survival. I thought this case might prove of interest.