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<h2><strong>Title:</strong> <a href="https://umem.org/educational_pearls/4694/">Challenging Management Dogma - Bicarb Administration in Severe Metabolic Acidosis</a></h2>
<p><strong>Category:</strong> <a href="https://umem.org/educational_pearls/?category=10">Critical Care</a></p>
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<strong>Posted:</strong> 1/14/2025 by <a href="https://umem.org/educational_pearls/?author=1583">Caleb Chan, MD</a>
<br/>
<a href="https://umem.org/profiles/faculty/1583/">Click here to contact Caleb Chan, MD</a>
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<p>These 2 papers challenge management dogmas in critical care that have persisted despite low-quality/absent evidence.</p>
<p>In particular, one explores the dogma, “bicarbonate improves ventricular contractility in severe metabolic acidosis,†with the following points: </p>
<p>-intracellular pH (which has a large impact on myocardial contractility) correlates poorly with blood gas pH</p>
<p>-many of the studies regarding bicarbonate in severe metabolic acidosis and hemodynamics are done on animal shock models</p>
<p>-two studies in patients with lactic acidosis showed increase in pH with bicarb administration without beneficial impact on hemodynamics (even in pts with pH < 7.1)</p>
<p>-bicarb administration is associated with hypernatremia, hypokalemia, and decreased ionized calcium levels</p>
<h3>References</h3>
<p>Hofmaenner DA, Singer M. Challenging management dogma where evidence is non-existent, weak or outdated. <em>Intensive Care Med</em>. 2022;48(5):548-558.</p>
<p>Hofmaenner DA, Singer M. Challenging management dogma where evidence is non-existent, weak, or outdated: part II. <em>Intensive Care Med</em>. 2024;50(11):1804-1813.</p>
<h3>View this pearl on the University of Maryland, Department of Emergency Medicine's website: <a href="https://umem.org/educational_pearls/4694/">https://umem.org/educational_pearls/4694/</a></h3>
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