Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review
Executive Summary Sodium bicarbonate is a cornerstone of clinical practice, frequently utilized to treat life-threatening conditions such as cardiac arrest, hyperkalemia , and various forms of metabolic acidosis . However, its use remains a subject of intense debate due to a persistent gap between theoretical benefits and clinical evidence . While administered to rapidly normalize arterial blood gas (ABG) parameters and restore hemodynamic stability , sodium bicarbonate is associated with significant physiological risks, including paradoxical intracellular and cerebrospinal fluid (CSF) acidosis, impaired oxygen delivery, and electrolyte imbalances . Current clinical data suggests that routine administration often lacks efficacy in improving mortality and may even worsen outcomes in specific scenarios, such as rhabdomyolysis or out-of-hospital cardiac arrest . Emerging evidence indicates that the benefit of sodium bicarbonate may be limited to specific subgroups , particularl...