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Bicarbonate for severe lactic acidosis from shock?
- In critically ill patients, one of the most common causes of acidosis is hypoperfusion induced lactic acidosis
- Importantly, the source of lactic acid during hypoperfusion/shock is intracellular, and the intracellular compartment is not readily accessible to extracellular bicarb
- Exogenous bicarbonate will certainly raise extracellular pH but does not readily correct intracellular acidosis
- This increase in pH is transient and typically lasts approximately 30 minutes
- In studies to date, exogenous bicarbonate did raise pH, serum bicarbonate concentrations, and PaCO2 but importantly did not improve cardiac output, mean arterial pressure, or sensitization to catecholamines
- Take Home Point: Based on available literature, there is no utility to giving bicarbonate in hypoperfusion induced lactic acidosis when the pH is > 7.0
References
Boyd JH, Walley KR. Is there a role for sodium bicarbonate in treating lactic acidosis from shock? Curr Opin Crit Care 2008;14:379-83.