Treatment of Acidosis: Sodium Bicarbonate and Other Drugs

  • G. A. Schmidt
Conference paper


Lactic acidosis, defined as a lactate level > 5 mmol/1 and a pH 7.35, is far and away the most-important acidosis during critical illness and most of this discussion of acidosis treatment will focus on treatment of lactic acidosis. Even in the face of maximal supportive therapy, lactic acidosis is associated with a mortality of 60-90% [1, 2, 3, 4], so physicians have long relied on treatments to lower the [H+], such as sodium bicarbonate. Less common than lactic acidosis, and much more amenable to conventional treatments, are ketoacidoses and respiratory acidosis, but these too occasionally prompt consideration of alkalinizing therapies. Lowering the [H+] in blood depends on manipulating the strong ion difference ([SID]), total concentration of non-volatile weak acid buffer (ATOT), or arterial CO2 tension (PaCO2), or raising the total concentration of weak bases, BTOT (normally sufficiently small that it can be ignored). Therefore, potential treatments include:

1. Raise [SID]: a) add strong cations: bicarbonate, carbicarb, dialysis b) remove strong anions: dichloroacetate (DCA), dialysis, thiamine, riboflavin, vasoactive drugs?

2. Lower the paCO2: raise VE or lower VD/VT or VCO2

3. Reduce ATOT: remove albumin, but very limited effect

4. Raise BTOT: tromethamine


Acute Lung Injury Sodium Bicarbonate Acute Respiratory Distress Syndrome Lactic Acidosis Diabetic Ketoacidosis 
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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • G. A. Schmidt
    • 1
  1. 1.Department of Clinical Medicine and Anaesthesia/Critical CareUniversity of ChicagoChicagoUSA

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