Sodium Bicarbonate Controversy in Lactic Acidosis

Çuhaci, Bülent; Lee, Jean; Ahmed, Ziauddin

doi:10.1378/chest.118.3.882

Cited by 20 publications

(5 citation statements)

References 8 publications

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“…However, although acidemia correction with administration of bicarbonates aims to normalize extracellular and intracellular pH and improve outcome [ 11 ], several studies suggest that this approach is overly simplistic [ 36 ] and the impact of bicarbonate administration on restoring hemodynamics, reducing vasopressor requirements, and improving clinical outcomes is unknown [ 21 ]. In 2000, a comment published in “Chest” by Cuhaci in response to an earlier study by Forsythe and Schmidt [ 36 ] criticized the suggestion to not routinely use bicarbonates in lactic acidosis and questioned whether rejection of a reasonable therapeutic option is wise, when this option does not cause harm and there are no proven alternative options [ 37 ]. This comment likely reflects clinical practice, as evidenced by a survey published in 2006, which showed that 67% of 48 intensivists who responded to the survey would give bicarbonate for treatment of lactic acidosis [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate

Velissaris

Karamouzos

Ktenopoulos

et al. 2015

Critical Care Research and Practice

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Introduction. Sepsis and its consequences such as metabolic acidosis are resulting in increased mortality. Although correction of metabolic acidosis with sodium bicarbonate seems a reasonable approach, there is ongoing debate regarding the role of bicarbonates as a therapeutic option. Methods. We conducted a PubMed literature search in order to identify published literature related to the effects of sodium bicarbonate treatment on metabolic acidosis due to sepsis. The search included all articles published in English in the last 35 years. Results. There is ongoing debate regarding the use of bicarbonates for the treatment of acidosis in sepsis, but there is a trend towards not using bicarbonate in sepsis patients with arterial blood gas pH > 7.15. Conclusions. Routine use of bicarbonate for treatment of severe acidemia and lactic acidosis due to sepsis is subject of controversy, and current opinion does not favor routine use of bicarbonates. However, available evidence is inconclusive, and more studies are required to determine the potential benefit, if any, of bicarbonate therapy in the sepsis patient with acidosis.

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Section: Discussionmentioning

confidence: 99%

The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate

Velissaris

Karamouzos

Ktenopoulos

et al. 2015

Critical Care Research and Practice

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“…Although some argue that bicarbonate administration is not indicated during hyperlactatemia regardless of the level of arterial pH [44], others advocate its continued use to maintain a living milieu reasonably close to the physiological one [45]. When used to treat acidosis the clinician must appreciate the possible harmful effects of bicarbonate administration and its limited effects on tissue oxygen delivery [46,47,48].…”

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confidence: 99%

Lactate: May I have your votes please?

Bakker

2000

Intensive Care Med

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“…For laboratory measurements, negative values were removed (apart from the measurements of base excess, which allowed negative results). Values generally incompatible with human life were published only for a relatively small number of analytes [ 28 ], and measurements outside the following limits were excluded on the basis of such published limits for chloride (<65 or >138 mmol/L) [ 29 ], plasma pH (<6.8 or >7.8) [ 30 , 31 ], potassium (<1.3 or >9.0 mmol/L) [ 29 ], and sodium (<100 or >191 mmol/L) [ 29 ].…”

Section: Methodsmentioning

confidence: 99%

Machine Learning Prediction of Hypoglycemia and Hyperglycemia From Electronic Health Records: Algorithm Development and Validation

Witte¹,

Nakas²,

Bally³

et al. 2022

JMIR Form Res

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Background Acute blood glucose (BG) decompensations (hypoglycemia and hyperglycemia) represent a frequent and significant risk for inpatients and adversely affect patient outcomes and safety. The increasing need for BG management in inpatients poses a high demand on clinical staff and health care systems in addition. Objective This study aimed to generate a broadly applicable multiclass classification model for predicting BG decompensation events from patients’ electronic health records to indicate where adjustments in patient monitoring and therapeutic interventions are required. This should allow for taking proactive measures before BG levels are derailed. Methods A retrospective cohort study was conducted on patients who were hospitalized at a tertiary hospital in Bern, Switzerland. Using patient details and routine data from electronic health records, a multiclass prediction model for BG decompensation events (<3.9 mmol/L [hypoglycemia] or >10, >13.9, or >16.7 mmol/L [representing different degrees of hyperglycemia]) was generated based on a second-level ensemble of gradient-boosted binary trees. Results A total of 63,579 hospital admissions of 38,250 patients were included in this study. The multiclass prediction model reached specificities of 93.7%, 98.9%, and 93.9% and sensitivities of 67.1%, 59%, and 63.6% for the main categories of interest, which were nondecompensated cases, hypoglycemia, or hyperglycemia, respectively. The median prediction horizon was 7 hours and 4 hours for hypoglycemia and hyperglycemia, respectively. Conclusions Electronic health records have the potential to reliably predict all types of BG decompensation. Readily available patient details and routine laboratory data can support the decisions for proactive interventions and thus help to reduce the detrimental health effects of hypoglycemia and hyperglycemia.

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Sodium Bicarbonate Controversy in Lactic Acidosis

Cited by 20 publications

References 8 publications

The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate

The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate

Lactate: May I have your votes please?

Machine Learning Prediction of Hypoglycemia and Hyperglycemia From Electronic Health Records: Algorithm Development and Validation

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