Importance of Metabolic Acidemia Viktor Rosival, Dérer's Hospital 3 January 2012 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 . The glycolytic enzyme phosphofructokinase is pH dependent, as its activity is decreasing with decreasing pH . Therefore, brain cells cannot utilise glucose . 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 . Without alkalising solutions, lethality is up to 100%, e g . Perhaps the decrease of lethality from 100% to zero% is a ¿beneficial effect¿? Dr. Viktor Rosival, PhD, SYNLAB department of laboratory medicine, Dérer's Hospital, Limbová 5 SK-833 05 Bratislava, Slovakia. e-mail: firstname.lastname@example.org 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.