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In the Emergency Room, Metabolic Acidosis that has not Recovered: Clinical Outcomes, Epidemiology, and Sodium Bicarbonate Therapy

Natasha Hilmes

Critically ill patients frequently suffer from acute metabolic acidosis. It has been linked to worse outcomes that prioritize the needs of the patient, such as an increase in hospital length of stay (LOS), admissions to the intensive care unit (ICU), and mortality rates. However, it is still not clear whether the acidosis itself or the disease that causes the acidosis are to blame for these outcomes.

In order to lessen the negative effects of decompensated metabolic acidosis, intravenous sodium bicarbonate (SB) is sometimes given to patients. However, previous research has shown that intensive care clinicians’ practices vary significantly across ICUs. The lack of large, multicenter randomized controlled trials (RCTs) contributes to the therapeutic uncertainty that these observations highlight. However, the recent BICAR-ICU trial demonstrated that SB reduced mortality in patients with acute kidney injury (AKI) and decompensated metabolic acidosis, reviving interest in SB therapy for ICU patients.

Epidemiological studies of patients in the emergency department (ED) have not yet replicated the aforementioned ICU data. However, such research is necessary to comprehend the prevalence of decompensated metabolic acidosis at initial hospital presentation and the current treatment for it. As a result, we conducted an epidemiological study to test the hypothesis that, in patients with arterial blood gas (ABG)-confirmed decompensated metabolic acidosis who presented to the emergency department (ED), SB would be used in a small percentage of patients and given at a low dose of approximately 100 mmol, as was recently observed in the ICU.