Intravenous Sodium Bicarbonate in Treating Patients With Severe Metabolic Acidemia

Acute metabolic acidemia, defined as a decrease in blood pH originating from a primary reduction in plasma bicarbonate concentration that is accompanied by an appropriate secondary reduction in Paco2 and is present for up to a few days, can impair hemodynamics and increase mortality, particularly when severe (arterial blood pH<7.20).1,2 In addition to supporting the circulation and ventilation as needed, addressing the underlying cause is the most effective means of treatment.3 However, administration of base primarily in the form of intravenous sodium bicarbonate to improve blood pH and that of the intracellular and interstitial compartments is also recommended by some experts4 and practiced by many, but not all, nephrologists or critical care physicians.

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