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• W2963264787 endingPage "536" @default.
• W2963264787 startingPage "528" @default.
• W2963264787 abstract "ABSTRACT Lactic acidosis occurs commonly and can be a marker of significant physiologic derangements. However what an elevated lactate level and acidemia connotes and what should be done about it is subject to inconsistent interpretations. This review examines the varied etiologies of lactic acidosis, the physiologic consequences, and the known effects of its treatment with sodium bicarbonate. Lactic acidosis is often assumed to be a marker of hypoperfusion, but it can also result from medications, organ dysfunction, and sepsis even in the absence of malperfusion. Acidemia causes deleterious effects in almost every organ system, but it can also have positive effects, increasing localized blood flow and oxygen delivery, as well as providing protection against hypoxic cellular injury. The use of sodium bicarbonate to correct severe acidemia may be tempting to clinicians, but previous studies have failed to show improved patient outcomes following bicarbonate administration. Bicarbonate use is known to decrease vasomotor tone, decrease myocardial contractility, and induce intracellular acidosis. This suggests that mild to moderate acidemia does not require correction. Most recently, a randomized control trial found a survival benefit in a subgroup of critically ill patients with serum pH levels <7.2 with concomitant acute kidney injury. There is no known benefit of correcting serum pH levels ≥ 7.2, and sparse evidence supports bicarbonate use <7.2. If administered, bicarbonate is best given as a slow IV infusion in the setting of adequate ventilation and calcium replacement to mitigate its untoward effects." @default.
• W2963264787 created "2019-07-30" @default.
• W2963264787 creator A5003159465 @default.
• W2963264787 creator A5016038499 @default.
• W2963264787 creator A5040084941 @default.
• W2963264787 creator A5043213282 @default.
• W2963264787 date "2020-05-01" @default.
• W2963264787 modified "2023-10-01" @default.
• W2963264787 title "Lactic Acidosis and the Role of Sodium Bicarbonate: A Narrative Opinion" @default.
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• W2963264787 doi "https://doi.org/10.1097/shk.0000000000001415" @default.
• W2963264787 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/31318832" @default.
• W2963264787 hasPublicationYear "2020" @default.
• W2963264787 type Work @default.

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