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Ammonia—not the culprit
  1. LARS WIKLUND,
  2. GUNNAR RONQUIST,
  3. MARY GEORGE
  1. Department of Anaesthesia
  2. Uppsala University Hospital
  3. Uppsala, Sweden
  4. Lars.Wiklund{at}anestesi.uas.lul.se

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    Editor,—We were interested to read the article by Kerr et al on the SIDS problem. With regard to the interesting results we would like to point out some related findings. As pointed out by Kerr et al,H pylori is abundant in less advantageous parts of society where smoking is often frequent, and sometimes where SIDS occurs. The fact that smoking is often inversely related to the ability of H pylori to colonise and to be transmitted from mother to child1 might indicate that it is sensitive to smoke itself, or products generated after smoke inhalation. It is interesting to note that endogenous products of smoke, like nitrate and nitrite, often inhibit bacterial growth.2 3

    Furthermore, we have previously shown that total breakdown of all ingested urea takes place in all normal infants without causing problems of ammonia intoxication.3 This is in contrast to SIDS victims, most of whom have unmetabolised urea in their faeces.4 Due to these related circumstances it may seem a little adventurous to suggest that ammonia produced byH pylori could cause death in SIDS.

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