Oral Bicarbonate Therapy in Patients with Normal pH

Clinical Rationale for Not Using Bicarbonate with Normal pH

• The Surviving Sepsis Campaign guidelines explicitly recommend against sodium bicarbonate therapy even in patients with hypoperfusion-induced lactic acidemia with pH ≥ 7.15, making it even less appropriate for patients with normal pH (7.35-7.45) 1, 3
• Bicarbonate administration in patients with normal pH may induce or worsen alkalosis, which carries its own risks including hypokalemia, decreased ionized calcium, and impaired oxygen delivery 1

Potential Adverse Effects of Unnecessary Bicarbonate Administration

• Sodium and fluid overload, which can worsen hypertension and precipitate heart failure 1

Limited Clinical Scenarios Where Bicarbonate May Be Considered Despite Normal pH

• Chronic kidney disease with normal pH but low serum bicarbonate (<22 mmol/L), as recommended by Kidney Disease Improving Global Outcomes (KDIGO) guidelines 4