Bicarbonate Use for Lactic Acidosis?

• The administration of sodium bicarbonate to treat severe acidosis remains controversial and intensely debated.
• Often, sodium bicarbonate is administered to critically ill ED patients with a lactic acidosis and pH < 7.2 while awaiting definitive therapy directed at the inciting event. 
• Wardi and colleagues recently conducted a narrative review of the literature on sodium bicarbonate use in select critical conditions commonly encountered in the ED.
• In their review, the authors found that sodium bicarbonate had no effect on mortality in critically ill patients with a pH < 7.2.  In addition, bicarbonate had no effect on hemodynamics in patients with a lactic acidosis receiving vasopressor therapy.
• With the potential exception of patients with severe acidosis and AKI, the authors conclude that sodium bicarbonate is not recommended for the treatment of lactic acidosis or shock states.

References

Wardi G, et al. A review of bicarbonate use in common clinical scenarios. J Emerg Med. 2023; online ahead of print.