A child presents with peripheral circulatory failure. The aerial pH is 7.0, pCO2 of 15 mmHg, p0276 mmHg. Which of the following will be the immediate therapy-

Ans. is b' i.e., Bolus of Ringers lactate It is a case of metabolic acidosis (lactic acidosis) due to peripheral circulatory failure (It is a common knowledge that in cases of peripheral circulatory failure metabolic acidosis occurs due to production of lactic acid). In moderate or mild cases of metabolic acidosis i.e., when the pH is > 7.2 metabolic acidosis needs no specific t/t. T/T of the underlying cause is sufficient.(it will correct the acidosis) Once the underlying cause (here tissue perfusion) is corrected the pH will return to normal But when the pH is < 7.2 specific bicarbonate therapy is warranted because this degree of acidosis may depress cardiac contractility. According to Harrison "In general severe acidosis (pH < 7.20) warrant the intravenous administration of 50-100 meq of NaHCO3 over 30-45 minutes during the initial, 1 to 2 hours of therapy". So here, besides fluid administration to correct tissue perfusion, HCO3 transfusion is also required because pH is 7. The question is which complication should be first attended to, peripheral circulatory failure or severe metabolic acidosis. Harrison states: "The underlying condition that disrupts lactate metabolism must first be corrected, tissue perfusion must be restored when it is inadequate".