Bicarbonate for severe lactic acidosis from shock?
In critically ill patients, one of the most common causes of acidosis is hypoperfusion induced lactic acidosis
Importantly, the source of lactic acid during hypoperfusion/shock is intracellular, and the intracellular compartment is not readily accessible to extracellular bicarb
Exogenous bicarbonate will certainly raise extracellular pH but does not readily correct intracellular acidosis
This increase in pH is transient and typically lasts approximately 30 minutes
In studies to date, exogenous bicarbonate did raise pH, serum bicarbonate concentrations, and PaCO2 but importantly did not improve cardiac output, mean arterial pressure, or sensitization to catecholamines
Take Home Point: Based on available literature, there is no utility to giving bicarbonate in hypoperfusion induced lactic acidosis when the pH is > 7.0
References
Boyd JH, Walley KR. Is there a role for sodium bicarbonate in treating lactic acidosis from shock? Curr Opin Crit Care 2008;14:379-83.
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