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Sir,The patient described by Darwich and Allaf1 is unlikely to suffer from simple metabolic acidosis. It is more likely that their patient suffered from a mixed disorder, namely, metabolic acidosis and respiratory alkalosis. This is because, if we calculate the expected pCO2 for the degree of hypobicarbonataemia in their patient according to the formula2:
pCO2 = ((1.5)(HCO3) +8) ± 2
the value we obtain (21.5±2) is significantly higher than the measured pCO2 of 9.5. A superimposed respiratory alkalosis with metabolic acidosis would explain the low pCO2 found in their patient.
It would be interesting to know whether an underlying septic process was present that was treated with empirical antibiotic therapy.