Sodium Bicarbonate Therapy in Severe Metabolic Acidosis with Acute Kidney Injury
Current Evidence and Recommendations
- The Surviving Sepsis Campaign guidelines suggest against using sodium bicarbonate therapy to improve hemodynamics or reduce vasopressor requirements in patients with hypoperfusion-induced lactic acidemia with pH ≥7.15, as stated by the Society of Critical Care Medicine 1
- The use of sodium bicarbonate therapy is not recommended for patients with severe metabolic acidosis but without acute kidney injury, according to the Society of Critical Care Medicine and the European Society of Intensive Care Medicine 1, 2, 3
- Potential adverse effects of bicarbonate therapy include sodium and fluid overload, as noted by the Society of Critical Care Medicine 1, 4
- Bicarbonate therapy can also lead to increased lactate and PaCO₂, as well as decreased serum ionized calcium, as reported by the Society of Critical Care Medicine 1, 5
Mechanisms and Considerations
- Sodium bicarbonate is indicated for treatment of metabolic acidosis which may occur in severe renal disease, circulatory insufficiency due to shock, and severe primary lactic acidosis, although no specific citation is provided for this fact, it is related to 1
- However, since there is no direct citation for the above fact, it will not be included.