1 Coordinator of Pediatric Ambulatory Services James Whitcomb Riley Hospital for Children Indiana University Medical Center 1100 West Michigan Street Indianapolis, Indiana 46202
For the most part, the approach of Drs. Bierman and Pierson to the pediatric patient with status asthmaticus appears sound; however, I feel the following comments are in order.
It has been my experience and that of others that it is seldom necessary to correct an arterial pH of 7.25 to 7.35; I would recommend bicarbonate therapy only if the arterial pH is less than 7.252, 3 Though the authors have indicated their desire for intravenously administered fluids containing 5% glucose, it is worthwhile to stress the importance of glucose administration to younger children since it has been found that patients with status asthmaticus under the age of 4 years have significant ketonemia.2