Bicarb in severe LA

Q: All of the following are potential effects of bicarbonate therapy in lactic acidosis EXCEPT? - select one

A) increase partial pressure of carbon dioxide (pCO2)

B) decrease production of lactate

C) decreased ionized calcium

D) expansion of the extracellular space

E) increased serum sodium concentration

Answer: B

The use of bicarbonate therapy in patients with lactic acidosis remained controversial, but most clinicians agree that the benefit may offset risks when pH goes lower than 7.1. Between pH 7.1 and 7.2, it should be used judiciously. There is some weak evidence that bicarbonate therapy may potentially prevent the need for dialysis and improve survival (reference #1).

Exogenous bicarbonate in lactic acidosis aims to 'buy time' so the underlying disease process can be reversed.

All of the choices in the above questions are correct EXCEPT choice B. Rapid infusions of sodium bicarbonate may accelerate lactate production.

#acid-base

References:

1. Jaber S, Paugam C, Futier E, 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. Lancet 2018; 392:31.

2. Ahn S, Kim YJ, 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 Thorac Dis. 2018 Apr;10(4):2295-2302. doi: 10.21037/jtd.2018.03.124. PMID: 29850134; PMCID: PMC5949471.

3. Lo KB, Garvia V, Stempel JM, Ram P, Rangaswami J. Bicarbonate use and mortality outcome among critically ill patients with metabolic acidosis: A meta analysis. Heart Lung. 2020 Mar-Apr;49(2):167-174. doi: 10.1016/j.hrtlng.2019.10.007. Epub 2019 Nov 14. PMID: 31733880.