From the Guidelines
Bicarbonate supplementation in a patient with severe metabolic acidosis after a road traffic accident (RTA) should be stopped when the patient's pH is ≥ 7.15, as there is no evidence to support its use in improving hemodynamics or reducing vasopressor requirements at this level 1.
Key Considerations
- The decision to discontinue bicarbonate therapy should be based on the patient's acid-base status, rather than a specific target for serum bicarbonate levels or base deficit.
- Serial arterial blood gas measurements should be used to guide the decision to stop therapy, with a focus on the patient's pH level.
- It is essential to address the underlying cause of acidosis, such as tissue hypoperfusion, hemorrhagic shock, or renal failure, simultaneously with bicarbonate therapy.
Potential Risks and Benefits
- Bicarbonate therapy may be associated with sodium and fluid overload, an increase in lactate and Paco2, and a decrease in serum ionized calcium, but the directness of these variables to outcome is uncertain 1.
- The effect of sodium bicarbonate administration on hemodynamics and vasopressor requirements at lower pH, as well as the effect on clinical outcomes at any pH level, is unknown.
Clinical Guidance
- The primary goal is to treat the underlying cause of acidosis, with bicarbonate serving as a bridge therapy until definitive treatment takes effect.
- Bicarbonate therapy should be used cautiously, with careful monitoring of the patient's acid-base status and attention to potential complications.
- The use of sodium bicarbonate therapy should be guided by the patient's individual needs and clinical circumstances, rather than a rigid protocol or guideline.
From the Research
Stopping Bicarbonate Supplementation in RTA Patients
- The decision to stop bicarbonate supplementation in patients with severe metabolic acidosis after a road traffic accident (RTA) should be based on individual patient needs and clinical circumstances 2.
- In general, bicarbonate therapy can be discontinued when the patient's arterial blood pH returns to normal (≥ 7.2) and the underlying cause of the metabolic acidosis has been addressed 3.
- However, in patients with acute kidney injury, bicarbonate therapy may need to be continued to improve survival outcomes, as suggested by a multicentre, open-label, randomised controlled trial 4.
- It is essential to monitor the patient's acid-base status, electrolyte levels, and clinical condition closely to determine the optimal duration of bicarbonate supplementation 5, 6.
- The following factors should be considered when deciding to stop bicarbonate supplementation:
- Arterial blood pH: If the pH returns to normal (≥ 7.2), bicarbonate therapy can be discontinued.
- Underlying cause: If the underlying cause of the metabolic acidosis has been addressed, bicarbonate therapy can be stopped.
- Kidney function: If the patient has acute kidney injury, bicarbonate therapy may need to be continued.
- Clinical condition: The patient's overall clinical condition, including vital signs, electrolyte levels, and organ function, should be closely monitored to determine the optimal duration of bicarbonate supplementation.