Treatment of Metabolic Acidosis with Severe Metabolic Acidemia and Moderate-to-Severe Acute Renal Insufficiency
This protocol addresses intensive care patients presenting with severe metabolic acidemia — arterial pH at or below 7.20 with PaCO₂ below 45 mmHg — who also have moderate to severe acute renal insufficiency. This combination defines a high-acuity clinical scenario requiring a specific, evidence-supported approach.
Severe metabolic acidemia (arterial pH ≤ 7.20 and PaCO₂ < 45 mmHg) in the setting of moderate to severe acute renal insufficiency. The concurrent renal impairment is a key factor shaping the recommended intervention for this presentation.
Sodium bicarbonate administration is the central intervention for this presentation. The complete protocol specifies the preparation, titration strategy, and monitoring parameters.
Target: Arterial pH ≥ 7.30References
DOI: 10.1053/j.ajkd.2019.01.036
- Sodium bicarbonate should probably be administered to intensive care patients with severe metabolic acidemia (pH ≤ 7.20, PaCO₂ < 45 mmHg) and moderate to severe acute renal insufficiency (GRADE 2+, STRONG AGREEMENT).
- A controlled, randomized, prospective multicenter study in 400 patients (pH ≤ 7.20, blood bicarbonate ≤ 20 mmol/L and PaCO₂ ≤ 45 mmHg and blood lactate > 2 mmol/L or SOFA score > 4) compared the effect of sodium bicarbonate administration (4.2% q.s. pH ≥ 7.30) with the absence of such administration on a principal composite endpoint.