Sodium bicarbonate for metabolic acidosis

The purpose of this review is to discuss the consequences of severe metabolic acidosis on organ function, examine the physiological controversies surrounding pH correction with sodium bicarbonate, and review the results of recent randomized clinical trials evaluating the effects of sodium bicarbonate on patient-centered outcomes in patients with metabolic acidosis.

Recent evidence has primarily focused on the results of large multicenter randomized clinical trials, which have shown that sodium bicarbonate administration does not improve mortality in unselected patients with moderate to severe metabolic acidosis, with or without acute kidney injury. However, sodium bicarbonate may delay or reduce the need for kidney replacement therapy in some patients.

Severe metabolic acidosis is associated with organ dysfunction, and its correction with sodium bicarbonate, alongside treatment of the underlying cause, can be performed safely. Although a mortality benefit remains unlikely based on current evidence, sodium bicarbonate administration may be associated with a reduced need for kidney replacement therapy. Future studies aimed at identifying patient phenotypes that may benefit from this intervention are warranted.