Sodium Bicarbonate Helps Patients Avoid Renal Replacement Therapy

Severe metabolic acidosis in critically ill patients is associated with hemodynamic instability and short-term mortality, but whether managing acidosis with sodium bicarbonate is beneficial or harmful is unclear. Investigators in France randomized 389 critically ill patients with severe metabolic acidemia (i.e., pH, ≤7.20; bicarbonate, ≤20 mmol/L; partial pressure of carbon dioxide, ≤45 mm Hg) to receive either 4.2% sodium bicarbonate infusion or no treatment. Most patients were receiving vasopressors and mechanical ventilation; nearly half had acute kidney injury (AKI). In the control group, one quarter of patients received bicarbonate at some point.

Only 60% of patients in the treatment group achieved the target pH of ≥7.30 The primary out…