SEARCHNARRATIVE_REVIEWemergency medicine, critical care

narrative_review·emergency medicine, critical care, internal medicine, nephrology, endocrinology·PMC10530341

A Review of Bicarbonate Use in Common Clinical Scenarios

The Journal of emergency medicine · 8 authors, 3 centres

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TL;DR

This narrative review evaluates the evidence for sodium bicarbonate use in non-toxicologic metabolic acidosis, concluding that routine use is not warranted except in select conditions like severe non-anion gap metabolic acidosis or specific cardiac arrest etiologies.

Full summary

690 CHARS

The authors conducted a narrative review of the literature on sodium bicarbonate therapy for non-toxicologic metabolic acidosis. They searched databases for studies from 1990 to 2022, focusing on scenarios like lactic acidosis, cardiac arrest, diabetic ketoacidosis, rhabdomyolysis, and non-anion gap metabolic acidosis. The review concludes that there are few data demonstrating improved clinical outcomes with routine bicarbonate use in shock states, DKA, rhabdomyolysis, or cardiac arrest, except for specific cases like sodium channel blockade toxicity or hyperkalemia. Implications suggest emergency physicians should reserve bicarbonate for conditions with clear demonstrated benefit.

STUDY TYPE

narrative_review

SPECIALTY

emergency medicine

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AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10530341

A Review of Bicarbonate Use in Common Clinical Scenarios

The Journal of emergency medicine

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ABSTRACT

Background: The use of sodium bicarbonate to treat metabolic acidosis is intuitive, yet data suggest that not all patients benefit from this therapy. Objective: In this narrative review, we describe the physiology behind commonly encountered nontoxicologic causes of metabolic acidosis, highlight potential harm from the indiscriminate administration of sodium bicarbonate in certain scenarios, and provide evidence-based recommendations to assist emergency physicians in rationale use of sodium bicarbonate. Discussion: Sodium bicarbonate can be administered as a hypertonic push, as a resuscitation fluid, or as an infusion. Lactic acidosis and cardiac arrest are two common scenarios where there is limited benefit to routine use of sodium bicarbonate, although certain circumstances, such as patients with concomitant acute kidney injury and lactic acidosis may benefit from sodium bicarbonate. Patients with cardiac arrest secondary to sodium channel blockade or hyperkalemia also benefit from sodium bicarbonate therapy. Recent data suggest that the use of sodium bicarbonate in diabetic ketoacidosis does not confer improved patient outcomes and may cause harm in pediatric patients. Available evidence suggests that alkalinization of urine in rhabdomyolysis does not improve patient-centered outcomes. Finally, patients with a nongap acidosis benefit from sodium bicarbonate supplementation. Conclusions: Empiric use of sodium bicarbonate in patients with nontoxicologic causes of metabolic acidosis is not warranted and likely does not improve patient-centered outcomes, except in select scenarios. Emergency physicians should reserve use of this medication to conditions with clear benefit to patients.

CITATION EXPORT

Gabriel Wardi, Sarah Holgren, Arnav Gupta et al.. A Review of Bicarbonate Use in Common Clinical Scenarios. The Journal of emergency medicine. (2023). https://doi.org/10.1016/j.jemermed.2023.04.012

AUTHORS

8 · 3 CENTRES

Gabriel Wardi, Sarah Holgren, Arnav Gupta, Julia Sobel, Aaron Birch, Alex Pearce, Atul Malhotra, Christopher Tainter

*Department of Emergency Medicine, University of California at San Diego, San Diego, California
†Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California at San Diego, San Diego, California
‡Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology. University of California at San Diego, San Diego, California