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Previous data suggested that only the subset of critically ill patients with metabolic acidemia and acute kidney injury (AKI) benefits from sodium bicarbonate infusions. To confirm these preliminary findings, investigators randomized 640 adults with pH ≤7.2 (mean, 7.15) and moderate-to-severe AKI (i.e., more than doubling of serum creatinine levels or oliguria) to intravenous sodium bicarbonate or no bicarbonate.
Sodium bicarbonate (4.2%; 125–250 ml) was infused during 30 minutes, with infusions repeated to keep pH ≥7.3; the upper limit was 1000 ml in the first 24 hours. Most patients were in septic or hemorrhagic shock, were receiving vasopressor support, and had serum lactate >2 mmol/l. Nearly 15% of patients had chronic kidney dise…