- sodium bicarbonate
- Dialysis / hemofiltration
- 8.4% and 4.2% solution
- generates high CO2
- used to treat a metabolic acidosis if pH < 7.1 (controversial)
- improves vasopressor responsiveness
- may have role in decreasing contrast nephropathy
- adverse effects: paradoxical acidosis in the presence of low output, hypokalaemia, phlebitis
- Tris-hydroxymethyl aminomethane (THAM)
- commercially available weak alkali that buffers H+ ions
- buffering not associated with a CO2 rise
- adverse effects: hyperkalaemia, hypoglycaemia, extravasation necrosis, hepatic dysfunction
- equimolar combination of sodium carbonate and sodium bicarbonate
- generates a smaller rise in CO2 than sodium bicarbonate
- more consistently increases intracellular pH
- inconsistent effects on haemodynamics
- not commonly used clinically
- works by stimulating the pyruvate dehydrogenase complex which regulates the entry of pyruvate into tricarboxylic acid cycle
- increases pH
- decreases lactate
- RCTs have found no benefit in haemodynamics or patient outcome
- peritoneal dialysis effective at removing lactate
- bicarbonate-buffered haemofiltration is ineffective
- avoid lactate based buffers in those who with lactate acidosis or liver disease
References and Links
- CCC — Sodium bicarbonate use
- Gehlbach BK, Schmidt GA. Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit – the role of buffers. Crit Care. 2004 Aug;8(4):259-65. PMC522834.
- Hoste EA, Colpaert K, Vanholder RC, Lameire NH, De Waele JJ, Blot SI, Colardyn FA. Sodium bicarbonate versus THAM in ICU patients with mild metabolic acidosis. J Nephrol. 2005 May-Jun;18(3):303-7. PMID: 16013019.
- Kraut JA, Kurtz I. Use of base in the treatment of severe acidemic states. Am J Kidney Dis. 2001 Oct;38(4):703-27. PubMed PMID: 11576874.
- Morgan TJ. The meaning of acid-base abnormalities in the intensive care unit: part III — effects of fluid administration. Crit Care. 2005 Apr;9(2):204-11. PMC1175908.
- Naka T, Bellomo R. Bench-to-bedside review: treating acid-base abnormalities in the intensive care unit–the role of renal replacement therapy. Crit Care. 2004 Apr;8(2):108-14. PMC420038.