Skip to main content
Top
Published in: Critical Care 1/2021

Open Access 01-12-2021 | Acute Kidney Injury | Review

Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy

Authors: Kosuke Yagi, Tomoko Fujii

Published in: Critical Care | Issue 1/2021

Login to get access

Abstract

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://​www.​biomedcentral.​com/​collections/​annualupdate2021​. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://​link.​springer.​com/​bookseries/​8901.
Literature
1.
go back to reference Stewart PA. How to understand acid–base: a quantitative acid–base primer for biology and medicine. Elsevier; 1981. Stewart PA. How to understand acid–base: a quantitative acid–base primer for biology and medicine. Elsevier; 1981.
2.
go back to reference Morris CG, Low J. Metabolic acidosis in the critically ill: part 1. Classification and pathophysiology. Anaesthesia. 2008;63:294–301.CrossRefPubMed Morris CG, Low J. Metabolic acidosis in the critically ill: part 1. Classification and pathophysiology. Anaesthesia. 2008;63:294–301.CrossRefPubMed
3.
go back to reference Story DA, Morimatsu H, Bellomo R. Strong ions, weak acids and base excess: a simplified Fencl–Stewart approach to clinical acid–base disorders. Br J Anaesth. 2004;92:54–60.CrossRefPubMed Story DA, Morimatsu H, Bellomo R. Strong ions, weak acids and base excess: a simplified Fencl–Stewart approach to clinical acid–base disorders. Br J Anaesth. 2004;92:54–60.CrossRefPubMed
4.
go back to reference Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6:274–85.CrossRefPubMed Kraut JA, Madias NE. Metabolic acidosis: pathophysiology, diagnosis and management. Nat Rev Nephrol. 2010;6:274–85.CrossRefPubMed
5.
go back to reference Mochizuki K, Fujii T, Paul E, Anstey M, Pilcher DV, Bellomo R. Early metabolic acidosis in critically ill patients: a binational multicentre study. Crit Care Resusc. 2021;23:67–75.PubMed Mochizuki K, Fujii T, Paul E, Anstey M, Pilcher DV, Bellomo R. Early metabolic acidosis in critically ill patients: a binational multicentre study. Crit Care Resusc. 2021;23:67–75.PubMed
6.
go back to reference Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomized controlled, phase 3 trial. Lancet. 2018;392:31–40.CrossRefPubMed Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomized controlled, phase 3 trial. Lancet. 2018;392:31–40.CrossRefPubMed
7.
go back to reference Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16.CrossRefPubMed Kaukonen K-M, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311:1308–16.CrossRefPubMed
8.
go back to reference Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, et al. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care. 2011;15:R238.CrossRefPubMedPubMedCentral Jung B, Rimmele T, Le Goff C, Chanques G, Corne P, Jonquet O, et al. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care. 2011;15:R238.CrossRefPubMedPubMedCentral
9.
go back to reference Fujii T, Udy AA, Nichol A, Bellomo R, Deane AM, El-Khawas K, et al. Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: an international observational study. Crit Care. 2021;25:45.CrossRefPubMedPubMedCentral Fujii T, Udy AA, Nichol A, Bellomo R, Deane AM, El-Khawas K, et al. Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: an international observational study. Crit Care. 2021;25:45.CrossRefPubMedPubMedCentral
10.
go back to reference Gabow PA, Kaehny WD, Fennessey PV, Goodman SI, Gross PA, Schrier RW. Diagnostic importance of an increased serum anion gap. N Engl J Med. 1980;303:854–8.CrossRefPubMed Gabow PA, Kaehny WD, Fennessey PV, Goodman SI, Gross PA, Schrier RW. Diagnostic importance of an increased serum anion gap. N Engl J Med. 1980;303:854–8.CrossRefPubMed
11.
go back to reference Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis—a systematic review. Ann Intensive Care. 2011;1:23.CrossRefPubMed Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis—a systematic review. Ann Intensive Care. 2011;1:23.CrossRefPubMed
12.
go back to reference Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med. 2005;20:255–71.CrossRefPubMed Fall PJ, Szerlip HM. Lactic acidosis: from sour milk to septic shock. J Intensive Care Med. 2005;20:255–71.CrossRefPubMed
13.
go back to reference Luft D, Deichsel G, Schmülling RM, Stein W, Eggstein M. Definition of clinically relevant lactic acidosis in patients with internal diseases. Am J Clin Pathol. 1983;80:484–9.CrossRefPubMed Luft D, Deichsel G, Schmülling RM, Stein W, Eggstein M. Definition of clinically relevant lactic acidosis in patients with internal diseases. Am J Clin Pathol. 1983;80:484–9.CrossRefPubMed
14.
go back to reference Gunnerson KJ, Saul M, He S, Kellum JA. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care. 2006;10:R22.CrossRefPubMed Gunnerson KJ, Saul M, He S, Kellum JA. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit Care. 2006;10:R22.CrossRefPubMed
15.
go back to reference Brill SA, Stewart TR, Brundage SI, Schreiber MA. Base deficit does not predict mortality when secondary to hyperchloremic acidosis. Shock. 2002;17:459–62.CrossRefPubMed Brill SA, Stewart TR, Brundage SI, Schreiber MA. Base deficit does not predict mortality when secondary to hyperchloremic acidosis. Shock. 2002;17:459–62.CrossRefPubMed
16.
go back to reference Wildenthal K, Mierzwiak DS, Myers RW, Mitchell JH. Effects of acute lactic acidosis on left ventricular performance. Am J Phys. 1968;214:1352–9. Wildenthal K, Mierzwiak DS, Myers RW, Mitchell JH. Effects of acute lactic acidosis on left ventricular performance. Am J Phys. 1968;214:1352–9.
17.
go back to reference Huang YG, Wong KC, Yip WH, McJames SW, Pace NL. Cardiovascular responses to graded doses of three catecholamines during lactic and hydrochloric acidosis in dogs. Br J Anaesth. 1995;74:583–90.CrossRefPubMed Huang YG, Wong KC, Yip WH, McJames SW, Pace NL. Cardiovascular responses to graded doses of three catecholamines during lactic and hydrochloric acidosis in dogs. Br J Anaesth. 1995;74:583–90.CrossRefPubMed
18.
go back to reference Pedoto A, Caruso JE, Nandi J, Oler A, Hoffmann SP, Tassiopoulos AK, et al. Acidosis stimulates nitric oxide production and lung damage in rats. Am J Respir Crit Care Med. 1999;159:397–402.CrossRefPubMed Pedoto A, Caruso JE, Nandi J, Oler A, Hoffmann SP, Tassiopoulos AK, et al. Acidosis stimulates nitric oxide production and lung damage in rats. Am J Respir Crit Care Med. 1999;159:397–402.CrossRefPubMed
19.
go back to reference Orchard CH, Cingolani HE. Acidosis and arrhythmias in cardiac muscle. Cardiovasc Res. 1994;28:1312–9.CrossRefPubMed Orchard CH, Cingolani HE. Acidosis and arrhythmias in cardiac muscle. Cardiovasc Res. 1994;28:1312–9.CrossRefPubMed
20.
go back to reference Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically III patients who have lactic acidosis: a prospective, controlled clinical study. Ann Intern Med. 1990;112:492–8.CrossRefPubMed Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically III patients who have lactic acidosis: a prospective, controlled clinical study. Ann Intern Med. 1990;112:492–8.CrossRefPubMed
21.
go back to reference Mathieu D, Neviere R, Billard V, Fleyfel M, Wattel F. Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study. Crit Care Med. 1991;19:1352–6.CrossRefPubMed Mathieu D, Neviere R, Billard V, Fleyfel M, Wattel F. Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study. Crit Care Med. 1991;19:1352–6.CrossRefPubMed
22.
go back to reference Khazel AH, McLaughlin JS, Suddhimondala C, Atar S, Cowley RA. The effects of acidosis and alkalosis on cardiac output and peripheral resistance in humans. Am Surg. 1969;35:600–5.PubMed Khazel AH, McLaughlin JS, Suddhimondala C, Atar S, Cowley RA. The effects of acidosis and alkalosis on cardiac output and peripheral resistance in humans. Am Surg. 1969;35:600–5.PubMed
23.
go back to reference Fujii T, Udy A, Licari E, Romero L, Bellomo R. Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: a scoping and a systematic review. J Crit Care. 2019;51:184–91.CrossRefPubMed Fujii T, Udy A, Licari E, Romero L, Bellomo R. Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: a scoping and a systematic review. J Crit Care. 2019;51:184–91.CrossRefPubMed
24.
go back to reference Mark NH, Leung JM, Arieff AI, Mangano DT. Safety of low-dose intraoperative bicarbonate therapy: a prospective, double-blind, randomized study. The study of perioperative ischemia (SPI) research group. Crit Care Med. 1993;21:659–65.CrossRefPubMed Mark NH, Leung JM, Arieff AI, Mangano DT. Safety of low-dose intraoperative bicarbonate therapy: a prospective, double-blind, randomized study. The study of perioperative ischemia (SPI) research group. Crit Care Med. 1993;21:659–65.CrossRefPubMed
25.
go back to reference Hoste EA, Colpaert K, Vanholder RC, Lameire NH, De Waele JJ, Blot SI, et al. Sodium bicarbonate versus THAM in ICU patients with mild metabolic acidosis. J Nephrol. 2005;18:303–7.PubMed Hoste EA, Colpaert K, Vanholder RC, Lameire NH, De Waele JJ, Blot SI, et al. Sodium bicarbonate versus THAM in ICU patients with mild metabolic acidosis. J Nephrol. 2005;18:303–7.PubMed
26.
go back to reference Zhang Z, Zhu C, Mo L, Hong Y. Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis. Intensive Care Med. 2018;44:1888–95.CrossRefPubMed Zhang Z, Zhu C, Mo L, Hong Y. Effectiveness of sodium bicarbonate infusion on mortality in septic patients with metabolic acidosis. Intensive Care Med. 2018;44:1888–95.CrossRefPubMed
27.
go back to reference Walker BG, Phear DN, Martin FI, Baird CW. Inhibition of insulin by acidosis. Lancet. 1963;2:964–5.CrossRefPubMed Walker BG, Phear DN, Martin FI, Baird CW. Inhibition of insulin by acidosis. Lancet. 1963;2:964–5.CrossRefPubMed
28.
go back to reference Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013;47:970–5.CrossRefPubMed Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013;47:970–5.CrossRefPubMed
29.
go back to reference Weng YM, Wu S-H, Li WC, Kuo C-W, Chen SY, Chen JC. The effects of sodium bicarbonate during prolonged cardiopulmonary resuscitation. Am J Emerg Med. 2013;31:562–5.CrossRefPubMed Weng YM, Wu S-H, Li WC, Kuo C-W, Chen SY, Chen JC. The effects of sodium bicarbonate during prolonged cardiopulmonary resuscitation. Am J Emerg Med. 2013;31:562–5.CrossRefPubMed
30.
go back to reference Kim J, Kim K, Park J, Jo YH, Lee JH, Hwang JE, et al. Sodium bicarbonate administration during ongoing resuscitation is associated with increased return of spontaneous circulation. Am J Emerg Med. 2016;34:225–9.CrossRefPubMed Kim J, Kim K, Park J, Jo YH, Lee JH, Hwang JE, et al. Sodium bicarbonate administration during ongoing resuscitation is associated with increased return of spontaneous circulation. Am J Emerg Med. 2016;34:225–9.CrossRefPubMed
31.
go back to reference Wang C-H, Huang CH, Chang WT, Tsai MS, Yu PH, Wu YW, et al. The effects of calcium and sodium bicarbonate on severe hyperkalaemia during cardiopulmonary resuscitation: a retrospective cohort study of adult in-hospital cardiac arrest. Resuscitation. 2016;98:105–11.CrossRefPubMed Wang C-H, Huang CH, Chang WT, Tsai MS, Yu PH, Wu YW, et al. The effects of calcium and sodium bicarbonate on severe hyperkalaemia during cardiopulmonary resuscitation: a retrospective cohort study of adult in-hospital cardiac arrest. Resuscitation. 2016;98:105–11.CrossRefPubMed
32.
go back to reference Bar-Joseph G, Abramson NS, Kelsey SF, Mashiach T, Craig MT, Safar P, et al. Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation. Acta Anaesthesiol Scand. 2005;49:6–15.CrossRefPubMed Bar-Joseph G, Abramson NS, Kelsey SF, Mashiach T, Craig MT, Safar P, et al. Improved resuscitation outcome in emergency medical systems with increased usage of sodium bicarbonate during cardiopulmonary resuscitation. Acta Anaesthesiol Scand. 2005;49:6–15.CrossRefPubMed
33.
go back to reference Kawano T, Grunau B, Scheuermeyer FX, Gibo K, Dick W, Fordyce CB, et al. Prehospital sodium bicarbonate use could worsen long term survival with favorable neurological recovery among patients with out-of-hospital cardiac arrest. Resuscitation. 2017;119:63–9.CrossRefPubMed Kawano T, Grunau B, Scheuermeyer FX, Gibo K, Dick W, Fordyce CB, et al. Prehospital sodium bicarbonate use could worsen long term survival with favorable neurological recovery among patients with out-of-hospital cardiac arrest. Resuscitation. 2017;119:63–9.CrossRefPubMed
34.
go back to reference Vukmir RB, Katz L, Sodium Bicarbonate Study Group. Sodium bicarbonate improves out-come in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006;24:156–61. Vukmir RB, Katz L, Sodium Bicarbonate Study Group. Sodium bicarbonate improves out-come in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006;24:156–61.
35.
go back to reference Ahn S, Kim YJ, Sohn CH, Seo DW, Lim KS, Donnino MW, et al. Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study. J Thorac Dis. 2018;10:2295–302.CrossRefPubMed Ahn S, Kim YJ, Sohn CH, Seo DW, Lim KS, Donnino MW, et al. Sodium bicarbonate on severe metabolic acidosis during prolonged cardiopulmonary resuscitation: a double-blind, randomized, placebo-controlled pilot study. J Thorac Dis. 2018;10:2295–302.CrossRefPubMed
36.
go back to reference Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142:S366-468.CrossRefPubMed Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR, Hirsch KG, et al. Part 3: adult basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020;142:S366-468.CrossRefPubMed
37.
go back to reference Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016;375:122–33.CrossRefPubMed Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016;375:122–33.CrossRefPubMed
38.
go back to reference Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;379:1431–42.CrossRefPubMed Barbar SD, Clere-Jehl R, Bourredjem A, Hernu R, Montini F, Bruyère R, et al. Timing of renal-replacement therapy in patients with acute kidney injury and sepsis. N Engl J Med. 2018;379:1431–42.CrossRefPubMed
39.
go back to reference STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, United Kingdom Critical Care Research Group, Canadian Nephrology Trials Network, Irish Critical Care Trials Group, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med. 2020;383:240–51. STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, United Kingdom Critical Care Research Group, Canadian Nephrology Trials Network, Irish Critical Care Trials Group, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med. 2020;383:240–51.
Metadata
Title
Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy
Authors
Kosuke Yagi
Tomoko Fujii
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-021-03677-4

Other articles of this Issue 1/2021

Critical Care 1/2021 Go to the issue