Department of Emergency Medicine, University of California at San Diego, San Diego, California; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California at San Diego, San Diego, California.
Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology. University of California at San Diego, San Diego, California.
J Emerg Med. 2023 Aug;65(2):e71-e80. doi: 10.1016/j.jemermed.2023.04.012. Epub 2023 Apr 21.
The use of sodium bicarbonate to treat metabolic acidosis is intuitive, yet data suggest that not all patients benefit from this therapy.
In this narrative review, we describe the physiology behind commonly encountered nontoxicologic causes of metabolic acidosis, highlight potential harm from the indiscriminate administration of sodium bicarbonate in certain scenarios, and provide evidence-based recommendations to assist emergency physicians in the rational use of sodium bicarbonate.
Sodium bicarbonate can be administered as a hypertonic push, as a resuscitation fluid, or as an infusion. Lactic acidosis and cardiac arrest are two common scenarios where there is limited benefit to routine use of sodium bicarbonate, although certain circumstances, such as patients with concomitant acute kidney injury and lactic acidosis may benefit from sodium bicarbonate. Patients with cardiac arrest secondary to sodium channel blockade or hyperkalemia also benefit from sodium bicarbonate therapy. Recent data suggest that the use of sodium bicarbonate in diabetic ketoacidosis does not confer improved patient outcomes and may cause harm in pediatric patients. Available evidence suggests that alkalinization of urine in rhabdomyolysis does not improve patient-centered outcomes. Finally, patients with a nongap acidosis benefit from sodium bicarbonate supplementation.
Empiric use of sodium bicarbonate in patients with nontoxicologic causes of metabolic acidosis is not warranted and likely does not improve patient-centered outcomes, except in select scenarios. Emergency physicians should reserve use of this medication to conditions with clear benefit to patients.
碳酸氢钠用于治疗代谢性酸中毒的方法直观有效，但数据表明并非所有患者都能从这种治疗中获益。
在本篇综述中，我们描述了常见非毒性原因导致代谢性酸中毒的生理学基础，强调了在某些情况下滥用碳酸氢钠可能带来的潜在危害，并提供了基于证据的建议，以帮助急诊医师合理使用碳酸氢钠。
碳酸氢钠可以推注给予、作为复苏液给予或输注给予。乳酸酸中毒和心搏骤停是两种常见的不常规使用碳酸氢钠获益有限的情况，但某些情况下，如合并急性肾损伤和乳酸酸中毒的患者可能会从碳酸氢钠中获益。继发于钠通道阻滞剂或高钾血症的心搏骤停患者也从碳酸氢钠治疗中获益。最近的数据表明，在糖尿病酮症酸中毒中使用碳酸氢钠并不能改善患者结局，反而可能对儿科患者造成危害。现有证据表明，横纹肌溶解症尿液碱化并不能改善以患者为中心的结局。最后，非高阴离子间隙性酸中毒患者需要补充碳酸氢钠。
对于非毒性原因导致代谢性酸中毒的患者，经验性使用碳酸氢钠没有依据，且不太可能改善以患者为中心的结局，除非在某些特定情况下。急诊医师应将这种药物保留用于对患者有明确获益的情况。
