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The BICAR-ICU Trial and Practical Use of Bicarb in Metabolic Acidosis

Metabolic acidosis without elevation in the anion gap is more likely to respond to bicarb administration than acidosis with an elevated anion gap. You can think of non-gap acidosis as bicarb deficiency; by administering bicarb, you are repleting bicarb.

Bicarbonate administration is reasonable in severe metabolic acidemia secondary to uremic acidosis and in patients with both AKI and acidemia. Further research is needed to elucidate protocols and to clearly demonstrate benefits.

Bicarbonate administration is rarely recommended in both ketoacidosis and lactic acidosis unless the patient is in extremis as it has shown no clear benefit and may cause harm.

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  Anion Gap Acidosis is a "KILR"

Ever forget all the things that make up MUDPILES in your AG acidosis differential? Instead, consider the less-complicated mnemonic "KILR"!. K Ketoacidosis (diabetic, alcoholic, starvation). I Ingestion (salicylate, acetaminophen, methanol, ethylene glycol, CO, CN, iron, INH). L Lactic acidosis (infection, hemorrhage, hypoperfusion, alcohol, metformin). R Renal (uremia).

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Resources

Life in the Fastlane

In most cases, IV sodium bicarbonate is NOT necessary, NOT helpful, & may even be harmful in the treatment of metabolic acidosis.