Document Type
Article
Publication Title
Journal of Clinical Medicine
Abstract
Sodium bicarbonate has been used in the treatment of different pathologies, such as hyperkalemia, cardiac arrest, tricyclic antidepressant toxicity, aspirin toxicity, acute acidosis, lactic acidosis, diabetic ketoacidosis, rhabdomyolysis, and adrenergic receptors' resistance to catecholamine in patients with shock. An ongoing debate about bicarbonate's efficacy and potential harm has been raised for decades because of the lack of evidence supporting its potential efficacy. Despite the guidelines' restrictions, sodium bicarbonate has been overused in clinical practice. The overuse of sodium bicarbonate could be because of the desire to correct the arterial blood gas parameters rapidly instead of achieving homeostasis by treating the cause of the metabolic acidosis. Moreover, it is believed that sodium bicarbonate may reverse acidosis-induced myocardial depression, hemodynamic instability, ventricular arrhythmias, impaired cellular energy production, resistance to catecholamines, altered metabolism, enzyme suppression, immune dysfunction, and ineffective oxygen delivery. On the other hand, it is crucial to pay attention to the potential harm that could be caused by excessive sodium bicarbonate administration. Sodium bicarbonate may cause paradoxical respiratory acidosis, intracellular acidosis, hypokalemia, hypocalcemia, alkalosis, impaired oxygen delivery, cerebrospinal fluid acidosis, and neurologic dysfunction. In this review, we discuss the pathophysiology of sodium bicarbonate-induced adverse effects and potential benefits. We also review the most recent clinical trials, observational studies, and guidelines discussing the use of sodium bicarbonate in different pathologies.
DOI
10.3390/jcm13247822
Publication Date
12-21-2024
Keywords
acid–base balance, acute kidney injury, cardiac arrest, cerebrospinal fluid acidosis, diabetic ketoacidosis, high anion gap, lactic acidosis, metabolic acidosis, normal anion gap, resuscitation, rhabdomyolysis, sodium bicarbonate
ISSN
2077-0383
Recommended Citation
Eraky AM, Yerramalla Y, Khan A, Mokhtar Y, Wright A, Alsabbagh W, Franco Valle K, Haleem M, Kennedy K, Boulware C. Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review. Journal of Clinical Medicine. 2024; 13(24). doi: 10.3390/jcm13247822.
