Alkali therapy versus sodium chloride supplement in low birthweight infants with incipient late metabolic acidosis

Two hundred and eighty‐two patients with birthweights below 2.0 kg were routinely screened for spontaneous development of maximum renal acid stimulation (urine‐pH < 5.4). Sixty episodes in 53 patients of incipient late metabolic acidosis (urine pH < 5.4 on 2 consecutive days) were randomly allocated to oral therapy with 2 mmol/kg/day of either NaHCO 3 or NaCl for 7 days. All 27 patients on NaHCO 3 therapy, but only 15 from 26 patients on NaCl therapy, showed an increase in urine pH values, combined with a relatively high gain in body weight and a tendency to increased N‐assimilation. Eleven patients on NaCl therapy showed persistent maximal renal acid stimulation on all 7 days with possibly lower weight gain and no clear change in N‐assimilation. Thus, in patients with incipient late metabolic acidosis, NaCl therapy is not as beneficial as NaHCO 3 therapy.