1. The underlying cause should be identified and treated where possible rather than administering alkali or manipulating minute volume to normalise the arterial pH.

2. Urgent haemo(dia)filtration may be necessary if oliguria persists.

3. Reversal of the metabolic acidosis (other than simple buffering with bicarbonate) is generally an indication of successful therapy. An increasing base deficit suggests that the therapeutic manoeuvres in operation are either inadequate or wrong.

4. The benefits of buffers such as Carbicarb and THAM (tris-hydroxy-methyl-aminomethane) remain unproved and are not generally available.

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