![]() However, its use is suggested in a subset of patients with septic shock, severe metabolic acidemia (pH ≤7.2), and AKI (with AKIN score of 2 or 3) as per the results of the BICAR-ICU trial. In the 2021 Surviving Sepsis Campaign guidelines, a weak recommendation was made against the use of sodium bicarbonate overall to improve hemodynamics or reduce vasopressor requirements. John Field talks about the UKLS trial, in which low-dose CT screening of high-risk adults was associated with a reduced rate of lung cancer mortality. The use of IV sodium bicarbonate as a buffer in lactic acidosis is controversial. NEJM Group Conference Updates IASLC 2021 World Conference on Lung Cancer Free. However, if a patient is acidemic, remember to consider other etiologies, including alternative causes of lactic acidosis and acidosis from diabetic ketoacidosis (DKA), toxic ingestions, and other causes. Lactic acidosis from septic shock is the most common acid–base disturbance in the medical ICU. (Source: Physiological Approach to Assessment of Acid–Base Disturbances. N Engl J Med 2014.) To convert the values for PaCO2, PaO2, and the alveolar–arterial difference to kilopascals, multiply by 0.1333. PaCO2 denotes partial pressure of arterial carbon dioxide (mm Hg), and PaO2 partial pressure of arterial oxygen (mm Hg). Reference values for the alveolar–arterial (A–a) oxygen tension difference are less than 10 mm Hg in young persons and less than 20 mm Hg in the elderly. ![]()
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