Abstract

Background: Acute metabolic acidemia, defined as a decrease in blood pH originating from a primary reduction in bicarbonate concentration that is accompanied by an appropriate secondary reduction in PaCO2 and is present for up to a few days, can impair hemodynamics and increase mortality, particularly when severe (arterial blood pH<7.20). Septic shock constitutes an important cause of morbidity and mortality in the critically ill patient. The Surviving Sepsis Campaign recommends against treatment with bicarbonate in patients with lactic acidosis due to hypo perfusion when pH is >7.15 but does not explicate what should be done in cases with lower pH.

Methodology: Prospective randomized, Double-blind controlled study was conducted in ICU of Bangalore Medical College and Research Institute, Bangalore for a period of 4 months (November 2020 to February 2021). Sample size calculation was based on previous prospective, randomized double bind, controlled study by Jung B et al, calculated to be 27 in each group.

Results: Mean age of subjects in Study group was 43.7 ± 14.0 years and in control group was 43.3 ± 17.1 years. A statistically significant difference was found in mean final pH and HCO3 levels and with respect to need for ventilation and Multi Organ Dysfunction Syndrome among the groups.

Conclusion: Metabolic acidosis is a common acid-base disorder and its management should be directed by the current guidelines of therapy. Rational treatment of metabolic acidosis in sepsis is directed towards addressing the underlying causes of acidosis and optimizing tissue oxygen delivery through optimization of cardiopulmonary parameters. Limitations of the previous studies prevent reaching definite conclusions and further investigations are required in order to ensure the validity of this therapeutic approach.

• 1.   Kraut JA, Madias NE. Intravenous Sodium Bicarbonate in Treating Patients With Severe Metabolic Acidemia. Am J Kidney Dis. 2019 Apr;73(4):572-575.
• 2.   Velissaris D, Karamouzos V, Ktenopoulos N, Pierrakos C, Karanikolas M. The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate. Critical Care Research and Practice. 2015;2015:1–7.
• 3.   Ghauri SK, Javaeed A, Mustafa KJ, Podlasek A, Khan AS. Bicarbonate Therapy for Critically Ill Patients with Metabolic Acidosis: A Systematic Review. Cureus. 2019;11(3):e4297.
• 4.   Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, et al. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. a prospective, multiple-center study. Crit
• 5.   Halperin ML, Kamel KS. Some Observations on the Clinical Approach to Metabolic Acidosis. J Am Soc Nephrol. 2010 Jun 1;21(6):894-897.
• 6.   Kooter AJ, Nanayakkara PW. Sodium bicarbonate for critically ill patients with metabolic acidaemia, treatment or window dressing? J Emerg Crit Care Med 2018;2:74.
• 7.   Adeva-Andany MM, Fernández-Fernández C, Mouriño-Bayolo D, Castro-Quintela E, DomínguezMontero A. Sodium Bicarbonate Therapy in Patients with Metabolic Acidosis. Di Iorio BR, editor. The Scientific World Journal. 2014 Oct 21;2014:627673.
• 8.   El-Solh AA, Abou Jaoude P, Porhomayon J. Bicarbonate therapy in the treatment of septic shock: a second look. Internal and Emergency Medicine. 2010 Aug 1;5(4):341–7.
• 9.   Kim HJ, Son YK, An WS. Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis. PLoS One. 2013;8(6):e65283.
• 10.   Chen X, Ye J, Zhu Z. [The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia in septic shock]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2013 Jan;25(1):24–7.
• 11.   Samir Jaber, Catherine Paugam, Emmanuel Futier, Jean-Yves Lefrant, Sigismond Lasocki, Thomas Lesco et al . Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial.The Lancet .2018 ;6736(18):31080-8.
• 12.   Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med 1990; 112: 492–98.
• 13.   Ahn S, Kim Y-J, Sohn CH, Seo DW, Lim KS, Donnino MW, Kim WY: Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study. J
• 14.   Mintzer JP, Parvez B, Alpan G, LaGamma EF: Effects of sodium bicarbonate correction of metabolic acidosis on regional tissue oxygenation in very low birth weight neonates. J Perinatol. 2015, 35:601-6.
• 15.   Zhang Z, Zhu C, Mo L, Hong Y: Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis. Intensive Care Med. 2018, 44:1888-1895.
• 16.   Kim HJ, Son YK, An WS: Effect of sodium bicarbonate administration on mortality in patients with lactic acidosis: a retrospective analysis. PLoS One. 2013, 8:65283.
• 17.   Dakhale GN, Hiware SK, Shinde AT, Mahatme MS. Basic biostatistics for post-graduate students. Indian J Pharmacol. 2012;44(4):435-442.
• 18.   Sunder Rao P S S, Richard J: An Introduction to Biostatistics, A manual for students in health sciences, New Delhi: Prentice hall of India. 4th edition. 2006; 86-160.
• 19.   Elenbaas, RM, Elenbaas, JK, Cuddy, PG. Evaluating the medical literature, part II: Statistical analysis. AnnEmerg Med. 1983; 12:610–620.

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