New Insights on Sodium Bicarbonate in Critical Care

Medical News: Sodium bicarbonate has long been a staple in medical treatments for a variety of conditions, ranging from cardiac arrest and acidosis to specific toxicological emergencies. Its use spans decades, but debates about its benefits versus its risks remain ongoing. A recent comprehensive review by researchers from institutions such as Freeman Health System in Joplin, Missouri-USA, Kansas City University-USA, University of Michigan Medical Schoo-USAl, Northern General Hospital in the UK, and Alexandria University in Egypt sheds new light on the complexities of sodium bicarbonate use in critically ill patients.

 
The study review explores its potential benefits, adverse effects, and the clinical contexts where its application might be more appropriate. This Medical News report will break down the key findings of this significant review in simple terms to help readers without a medical background understand its implications.
 
What Is Sodium Bicarbonate Used For?
Sodium bicarbonate is commonly employed to treat metabolic acidosis, a condition where the body’s blood becomes overly acidic. This can occur in situations such as diabetic ketoacidosis (DKA), lactic acidosis, kidney failure, and severe dehydration. The substance is also used in emergencies like cardiac arrest or toxic drug ingestion.
 
The treatment is thought to help neutralize acid in the bloodstream quickly, improving heart function and restoring balance to the body’s systems. However, it comes with risks, including potential respiratory complications and other serious side effects, which have sparked debates among clinicians.
 
Key Findings of the Study
This article delves into the findings, where researchers examined the impact of sodium bicarbonate on various patient groups. Here’s what they discovered:
 
-Impact on Neurological Status
Sodium bicarbonate’s effects on brain function were notable. While it may stabilize acid-base levels in some cases, it was also found to potentially induce a condition called cerebrospinal fluid (CSF) acidosis. This occurs because bicarbonate can rapidly increase carbon dioxide levels in the body, which cross into the brain and reduce the pH of the CSF. This process may lead to confusion, altered mental states, and other neurological issues in some patients.
 
Studies have shown that pre-hospital administration of sodium bicarbonate in cardiac arrest cases was associated with worse neurological outcomes upon discharge. For instance, it appears that the rapid shifts in pH and carbon dioxide levels disrupt the delicate balance in the brain’s environment. Additionally, bicarbonate’s influence on oxygen delivery and metabolic pathways in the brain is under scrutiny for its possible link to post-treatment complications.
 
-Effects on Oxygen Delivery
Another significant concern raised in the study is sodium bicarbonate’s impact on oxygen delivery to tissues. While correcting blood acidity might sound beneficial, the treatment can paradoxically hinder the body’s ability to release o xygen from hemoglobin. This occurs due to a shift in the oxygen-hemoglobin dissociation curve, which can reduce oxygen availability to vital organs.
 
In cases of severe acidosis, however, sodium bicarbonate may play a role in stabilizing patients, especially those on life support or requiring vasopressor medications. However, improper administration may exacerbate conditions, especially in patients with preexisting lung issues or poor ventilatory function.
 
-Effects on Kidney Function and Rhabdomyolysis
The role of sodium bicarbonate in patients with kidney damage or rhabdomyolysis - a condition where muscle breakdown releases harmful substances into the bloodstream - was examined extensively. The study found limited evidence supporting its routine use for protecting the kidneys or improving outcomes in rhabdomyolysis cases. In some instances, sodium bicarbonate was even associated with a higher risk of complications such as acute kidney injury.
 
Patients with rhabdomyolysis often face the risk of kidney failure due to the deposition of muscle proteins like myoglobin in the renal tubules. While sodium bicarbonate has been theorized to reduce this risk by alkalinizing the urine and preventing myoglobin precipitation, recent findings challenge its efficacy and even suggest that it could worsen outcomes in certain scenarios.
 
-Use in Diabetic Ketoacidosis (DKA)
In patients with DKA, sodium bicarbonate’s effectiveness remains questionable. The American Diabetes Association recommends against its routine use, except in cases where blood pH drops dangerously low. The study corroborates these guidelines, emphasizing that sodium bicarbonate might delay the resolution of acidosis in DKA patients and increase complications like low potassium and calcium levels.
 
For DKA patients, the primary treatment involves fluid replacement, insulin administration, and electrolyte correction. Adding sodium bicarbonate to the regimen has shown limited benefits and, in some cases, worsened clinical markers, such as delaying the clearance of ketone bodies and extending hospital stays.
 
-Controversies in Cardiac Arrest
One of the most debated uses of sodium bicarbonate is during cardiac arrest resuscitation. Early studies suggested potential benefits, but more recent research, including findings from this review, indicates mixed outcomes. While it might help in very specific scenarios - such as severe acidosis or certain drug toxicities - routine administration during resuscitation is not widely supported due to potential adverse effects, including increased intracellular acidosis and impaired oxygen delivery.
 
Sodium bicarbonate’s role during cardiac arrest resuscitation must be carefully considered. The treatment can lead to a buildup of carbon dioxide, worsening acidosis in some patients. Guidelines now recommend its use only in targeted situations, such as hyperkalemia or tricyclic antidepressant overdose.
 
-Insights on Mortality Rates
The study also reviewed the impact of sodium bicarbonate on mortality rates in critically ill patients. For many conditions, including severe acidosis, there was no significant difference in survival between patients who received sodium bicarbonate and those who did not. However, patients with severe metabolic derangements, such as concurrent kidney injury or hyperkalemia, appeared to benefit from targeted bicarbonate use.
 
-Administration Guidelines and Best Practices
The findings emphasize the importance of careful monitoring and individualized treatment plans. Sodium bicarbonate should be reserved for patients with clear indications, such as severe acidosis with pH levels below 7.1, and administered under strict medical supervision. Overuse or improper use can exacerbate existing conditions or introduce new complications.
 
-Conclusion and Recommendations
The study concludes that sodium bicarbonate should not be used indiscriminately in critical care. Its application must be tailored to individual patient needs, considering the severity of acidosis, underlying conditions, and potential risks. In specific cases, such as severe acidosis with concurrent kidney injury or hyperkalemia, sodium bicarbonate may be beneficial. However, its routine use in conditions like cardiac arrest or rhabdomyolysis should be approached with caution.
 
Healthcare providers are encouraged to base their decisions on updated clinical guidelines and carefully monitor patient responses to treatment. Further research is needed to refine the criteria for sodium bicarbonate use and to explore alternative treatments for metabolic acidosis.
 
The study findings were published in the peer-reviewed Journal of Clinical Medicine.
https://www.mdpi.com/2077-0383/13/24/7822
 
For the latest on the usage of Sodium Bicarbonate in Critical Care, keep on logging to Thailand Medical News.
 
Read Also:
https://www.thailandmedical.news/news/baking-soda-rescues-retinal-ganglion-cells-and-ameliorates-visual-dysfunction-caused-by-oxidative-stress-even-in-glaucoma
 
https://www.thailandmedical.news/news/breaking-egyptian-randomized-clinical-trial-shows-that-inhalable-sodium-bicarbonate-could-be-used-as-adjuvant-in-covid-19-treatment-protocols
 
https://www.thailandmedical.news/news/breaking-news-researchers-warn-that-covid-19-could-be-causing-rise-of-diabetic-ketoacidosis-incidences
 
https://www.thailandmedical.news/news/must-read!-diabetic-ketoacidosis:-report-says-most-hospitalized-covid-19-patients-will-develop-this-fatal-complication