The Use of Intravenous Sodium Bicarbonate in the Treatment of Metabolic Acidosis with Septic Shock

Abstract

Background: Acute metabolic acidemia, defined as a decrease in blood pH originating from a primary reduction in bicarbonate concentration that is accompanied by an appropriate secondary reduction in PaCO2 and is present for up to a few days, can impair hemodynamics and increase mortality, particularly when severe (arterial blood pH<7.20). Septic shock constitutes an important cause of morbidity and mortality in the critically ill patient. The Surviving Sepsis Campaign recommends against treatment with bicarbonate in patients with lactic acidosis due to hypo perfusion when pH is >7.15 but does not explicate what should be done in cases with lower pH. Methodology: Prospective randomized, Double-blind controlled study was conducted in ICU of Bangalore Medical College and Research Institute, Bangalore for a period of 4 months (November 2020 to February 2021). Sample size calculation was based on previous prospective, randomized double bind, controlled study by Jung B et al, calculated to be 27 in each group. Results: Mean age of subjects in Study group was 43.7 ± 14.0 years and in control group was 43.3 ± 17.1 years. A statistically significant difference was found in mean final pH and HCO3 levels and with respect to need for ventilation and Multi Organ Dysfunction Syndrome among the groups. Conclusion: Metabolic acidosis is a common acid-base disorder and its management should be directed by the current guidelines of therapy. Rational treatment of metabolic acidosis in sepsis is directed towards addressing the underlying causes of acidosis and optimizing tissue oxygen delivery through optimization of cardiopulmonary parameters. Limitations of the previous studies prevent reaching definite conclusions and further investigations are required in order to ensure the validity of this therapeutic approach.