Common clinical practices often are unsupported by experimental evidence. One example is the administration of sodium bicarbonate to neonates. Despite a long history of widespread use, objective evidence that administration of sodium bicarbonate improves outcomes for patients in cardiopulmonary arrest or with metabolic acidosis is lacking. Indeed, there is evidence that this therapy is detrimental. This review examines the history of sodium bicarbonate use in neonatology and the evidence that refutes the clinical practice of administering sodium bicarbonate during cardiopulmonary resuscitation or to treat metabolic acidosis in the NICU.
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Chapters Views & News
Copyright © 2008 by the American Academy of Pediatrics
2008
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Comments
Sodium bicarbonate and permissive acidemia
The article and the references cited clearly indicate that when managing metabolic acidosis primary focus should be directed in treating the underlying cause rather than using NaHCO3. My questions to authors are:
1. Is there any critical pH? 2. How low can we go with pH in neonates with metabolic acidosis without chemical intervention? 3. Is there any concept of permissive acidemial? 4. What are the chemical alternatives to the use of NaHCO3 in treating severe metabolic acidosis? 5. Is there any laboratory substitute for analysing acid-base status other that blood gas analysis (can't rely on extracellular pH and can't measure intracellular pH in clinical practice)
Sincerely,
Shabih Manzar, MD
Conflict of Interest:
None declared