Treatment of acute metabolic acidosis

Acute metabolic acidosis is a common complication in critically ill patients and is associated with increased morbidity and mortality. Management of acute metabolic acidosis varies widely in clinical practice, with limited randomized trial data to support a standardized approach. This review will provide an overview of the literature regarding the management of acute metabolic acidosis and the potential risks associated with these therapies.

Correction of metabolic acidosis with sodium bicarbonate has not been associated with a reduction in mortality, although does reduce the need for kidney replacement therapy in high-risk patients with coexisting moderate to severe acute kidney injury. Additionally, there is not a clear association between correction of acidosis and improvement in overall hemodynamics in critically ill patients. The risks of sodium bicarbonate therapy and kidney replacement therapy are not insignificant and must be thoughtfully weighed against the benefits of correcting a metabolic acidosis.

The management of acute metabolic acidosis should be tailored to the individual patient, with careful consideration of the risks and benefits associated with sodium bicarbonate use and kidney replacement therapy discussed in this review. Additional randomized human trials are needed to better define the role for these therapies in critically ill patients.