Current Evidence Surrounding the Use of Sodium Bicarbonate in the Critically Ill Patient

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• Forni LG, Hodgson LE, Selby NM. The Janus faces of bicarbonate therapy in the ICU: not sure!. Intensive Care Med. 2020;46(3):522–4. https://doi.org/10.1007/s00134-019-05885-7. Forni and colleagues discuss sodium bicarbonate therapy and the risk of causing intracellular acidosis, as well as a host of other issues, like oxygen delivery impairment, possible hypernatremia, and a hyperosmolar state. The authors also discuss the BICAR-ICU trial, in which sodium bicarbonate administration for those with severe metabolic acidosis and acute kidney injury may delay or even reduce the need for renal replacement therapy. While sodium bicarbonate may be used in such a fashion, the authors of this editorial emphasize treating the underlying cause.

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