Bicarbonate therapy in severely acidotic trauma patients increases mortality

Abstract

Therapeutic study, level IV.

Chloride content of solutions used for regional citrate anticoagulation might be responsible for blunting correction of metabolic acidosis during continuous veno-venous hemofiltration

“…To date, clinicians try to correct metabolic acidosis during CVVH by administering additional bicarbonate infusion [17, 22]. However, excess intravenous bicarbonate may cause unwarranted side-effects and even increase mortality [22].…”

“…To date, clinicians try to correct metabolic acidosis during CVVH by administering additional bicarbonate infusion [17, 22]. However, excess intravenous bicarbonate may cause unwarranted side-effects and even increase mortality [22]. Consequently, new citrate formulations have been implemented to avoid rebound metabolic alkalosis whilst assuring timely correction of acidosis and obviating the need to infuse intravenous bicarbonate.…”

Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis

“…Evidence that significant harmful effects are derived from metabolic acidosis by itself has not been provided in human beings [6–10] and therefore the successful management of metabolic acidosis requires the therapy of the underlying causative disorder [11]. Replacement of sodium bicarbonate is beneficial in disorders associated with loss of sodium bicarbonate, such as diarrhea and renal tubular acidosis, but symptomatic therapy with sodium bicarbonate to correct metabolic acidosis per se in other settings has not been demonstrated to ameliorate clinical outcomes or mortality (Table 1) [8, 10, 12–14]. Further, sodium bicarbonate supplementation fails to raise plasma pH or increases it only slightly in some patients affected with malignancy-associated lactic acidosis, while control of the underlying malignancy brings plasma pH to normal [15–22].…”

“…A negative impact on mortality has been reported following the use of sodium bicarbonate in a retrospective cohort study of severely acidotic (arterial pH ≤ 7.10) trauma patients who underwent emergency surgery [14]. No benefit from bicarbonate therapy has been found either in a small prospective randomized trial of patients who developed intraoperative mild metabolic acidosis in the absence of hypoxemia [41].…”

“…The infusion of sodium bicarbonate has been consistently associated with an increase in carbon dioxide production and a rise in arterial pCO 2 [14, 21, 22, 37, 40, 41, 97–101]. Excess carbon dioxide is normally cleared by pulmonary hyperventilation, but when sodium bicarbonate is administered to patients on mechanical ventilation, adjustments have to be made to remove the excess carbon dioxide [37, 40, 98, 100].…”