A 62-year-old man on ICU has type A lactic acidosis with a lactate of 12 mmol/L secondary to cardiogenic shock. His pH is 7.05, HCO3 8 mmol/L. The tea...

Question

A 62-year-old man on ICU has type A lactic acidosis with a lactate of 12 mmol/L secondary to cardiogenic shock. His pH is 7.05, HCO3 8 mmol/L. The team debates whether to administer IV sodium bicarbonate. What does the evidence suggest?

Accepted Answer

The 28-day BiCar trial (Jaber et al., 2018) found no overall mortality benefit of IV sodium bicarbonate in severe metabolic acidosis, but showed potential benefit in patients with AKI (AKIN 2-3) and pH ≤7.20

Answer

IV sodium bicarbonate should be given routinely for all lactic acidosis

Answer

Sodium bicarbonate is absolutely contraindicated in lactic acidosis

Answer

Sodium bicarbonate should replace vasopressor therapy

Answer

Oral sodium bicarbonate is equivalent to IV

uk-fficm MCQ (SBA): Sodium Bicarbonate in Acidosis

A 62-year-old man on ICU has type A lactic acidosis with a lactate of 12 mmol/L secondary to cardiogenic shock. His pH is 7.05, HCO3 8 mmol/L. The team debates whether to administer IV sodium bicarbonate. What does the evidence suggest?