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Editor,—The claim by Narchi1 that serum bicarbonate concentration does not reflect the severity of dehydration in children with gastroenteritis cannot be substantiated by the data; the clinical assessment of dehydration used in the study has already been shown to be unreliable. Mackenzie et al 2 showed that there is a marked discrepancy between the degree of clinically estimated dehydration and the actual degree, when calculated on the basis of early weight recovery in hospital. Many of the variables used in Narchi’s assessment were found to be poor predictors of dehydration, and the severity of dehydration was overestimated by, on average, 3.2%. Perhaps most importantly, the authors found a highly significant correlation between base deficit and the degree of (accurately estimated) dehydration. It would therefore be interesting to see if there was a similar correlation in Narchi’s data between dehydration (estimated on the basis of weight gain) and bicarbonate concentrations. In the meantime, Narchi’s conclusions are potentially flawed and should therefore be treated with the utmost caution.
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