The Effective Dosing Schedule of Sodium Bicarbonate for Improving pH in Patients with Metabolic Acidosis

Although sodium bicarbonate (NaHCO3) is still a commonly used treatment for metabolic acidosis, the best dosage methods are still unknown. This study compared the effectiveness of three distinct NaHCO3 regimens for the short-term treatment of moderate-to-severe metabolic acidosis.

60 adult ICU patients with metabolic acidosis (pH < 7.25) participated in a prospective randomized interventional study. Three groups of twenty patients each were randomly assigned. Over the course of a day, Group A received the calculated total bicarbonate dose. Group C received 30% of the dose as a bolus and 70% as an infusion, whereas Group B received 15% of the dose as an initial bolus and 85% as an infusion. End-tidal CO2 (EtCO₂) and arterial pH were measured at 0, 1, 8, 16, 24, 36, and 48 hours. Additionally, two-day survival was evaluated.

Blood pH significantly improved across all groups. With normalization by the sixteenth hour, Group C made the quickest correction. At 24th and 48th hours, Group B revealed the most consistent and sustained correction of pH with less variation. There was no significant ventilation effect, as supported by the gradual increase in EtCO2 levels in all three groups. The 2-day survival rate was slightly higher in Groups B and C (40%) than in Group A (30%), but the difference was not statistically significant.

Findings from the current investigation help illuminate the extent to which different bicarbonate dosing regimens can raise blood pH and influence the presence of metabolic acidosis over the two-day treatment period.

All bicarbonate treatment modalities were successful. Group C responded quickly, and Group B was the most consistent. The survival difference is not significant and highlights the need for further studies to improve dosing.