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September 8, 1989

Absence Seizures Associated With Bicarbonate Therapy and Normal Serum pH

JAMA. 1989;262(10):1328-1329. doi:10.1001/jama.1989.03430100062022

To the Editor.—  Renal tubular acidosis is known to cause failure to thrive.1,2 We found that treating children with this condition by oral administration of sodium bicarbonate is both beneficial and benign.

Report of a Case.—  A 2 1/2-year-old girl with failure to thrive and weight and height below the third percentile for her age was referred to our department. Extensive investigation revealed metabolic acidosis (pH, 7.3 to 7.33), with hypocarbonemia of 16 to 18 mEq/L and hyperchloremia of 116 to 117 mmol/L. After excluding other causes, a presumptive diagnosis of renal tubular acidosis was made and oral therapy with 4 mEq/kg per day of sodium bicarbonate was instituted. This raised her blood pH level to 7.41 to 7.43 and enabled the child to attain the 10th percentile of weight and height for her age.A month later, the child experienced four episodes of absencelike seizures. There was no