Sodium bicarbonate for the treatment of lactic acidosis

Lactic acidosis often challenges the intensivist and is associated with a s trikingly high mortality. Treatment involves discerning and correcting its underlying cause, ensuring adequate oxygen delivery to tissues, reducing ox ygen demand through sedation and mechanical ventilation, and (most controve rsially) attempting to alkalinize the blood with IV sodium bicarbonate. Her e we review the literature to answer the following questions: Is a low pH h ad? Can sodium bicarbonate raise the pH in vivo? Does increasing the blood pH with sodium bicarbonate have any salutary effects? Does sodium bicarbona te have negative side effects? We find that the oft-cited rationale for bic arbonate use, that it might ameliorate the hemodynamic expression of metabo lic acidemia, has been disproved convincingly. Further, given the lack of e vidence supporting its use, we cannot condone bicarbonate administration fo r patients with lactic acidosis, regardless of the degree of acidemia.