ICU SAQs · Acid–base
The role of sodium bicarbonate in severe metabolic acidaemia
A critical-appraisal question built on BICAR-ICU — the only large trial of bicarbonate in severe acidaemia — covering the negative primary result, the acute-kidney-injury subgroup signal, the physiological case against bicarbonate (intracellular acidosis, sodium load, hypercapnia, hypocalcaemia), and the residual indications (hyperkalaemia, peri-arrest, selected toxic ingestions, pre-dialysis).
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Prompt
Critically appraise the role of intravenous sodium bicarbonate in the patient with severe metabolic acidaemia. What is the evidence, what are the physiological objections to its use, and in which specific situations is it still justified?
Question
Critically appraise the role of intravenous sodium bicarbonate in the patient with severe metabolic acidaemia. What is the evidence, what are the physiological objections to its use, and in which specific situations is it still justified?[1]
[1]References4ShowHide
- [1]Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU). Lancet, 2018.PMID 29910040
- [2]Kraut JA, Madias NE. Lactic acidosis. New England Journal of Medicine, 2014.PMID 25494270
- [3]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [4]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.