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NeoReviews Vol.10 No.11 2009 e558
© 2009 American Academy of Pediatrics

Dogma Disputed

Why Intravenous Sodium Bicarbonate Doesn’t Work

Ronald L. Poland, MD*

* Professor of Pediatrics, Department of Pediatrics, Neonatology Division, University of New Mexico, Albuquerque, NM

Sodium bicarbonate is an ideal buffer for the treatment of metabolic acidosis if the following conditions are present: 1) the desired pH is close to 6.1, 2) the recipient has the ability to excrete instantly any additional carbon dioxide generated, and 3) the additional osmoles do not shift the pKa of all buffers downward. Unfortunately, none of these three conditions are met. Intravenous sodium bicarbonate might provide a benefit if the patient who has metabolic acidosis needs more extracellular fluid volume (eg, those who have lactic acidosis). However, in trials comparing the effect of sodium bicarbonate with sodium chloride or albumin, sodium bicarbonate was not superior. Consequently, the intravenous administration of sodium bicarbonate is not recommended for the treatment of newborns who have metabolic acidosis.


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