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Sodium bicarbonate significantly reduced the need of renal replacement therapy (risk ratio [RR] 0.69; 95% CI, 0.61–0.78) but not mortality (RR, 0.84; 95% CI, 0.55–1.30). However, there was not enough sample size to support the outcome of mortality.
There was still significant heterogeneity between studies as the sources of metabolic acidosis were different between different studies in this meta-analysis study of randomized control trial. One study recruited patients with septic shock only, while other studies enrolled patients with different disease states.
There was also heterogeneity in the threshold for pH to enter the study.
References
Sodium Bicarbonate for Acute Metabolic Acidosis in Critically Ill Adults: A Meta-Analysis of Randomized Clinical Trials. Chen, Jia-Jin MD; Lee, Tao-Han MD; Chang, Chih-Hsiang MD, PhD, Lai, Pei-Chun MD, PhD; Tu, Yu-Kang PhD; Huang, Yen-Ta MD, MSc, PhD. Critical Care Medicine ():10.1097/CCM.0000000000007179, May 22, 2026. | DOI: 10.1097/CCM.0000000000007179