Does Sodium Bicarbonate Therapy Benefit Patients in Shock?

Consequently, metabolic acidosis frequently occurs in critically ill patients suffering from shock, leading to severe organ failure. Clinicians widely prescribe sodium bicarbonate therapy to correct acidemia and improve hemodynamic stability. However, its clinical benefits in patients receiving vasopressors remain highly uncertain. Therefore, the recent SODa-BIC trial investigated whether this intervention truly improves patient outcomes in intensive care units.

The SODa-BIC Trial Methods

Initially, the investigators designed this pragmatic, adaptive, double-blind, randomized trial to evaluate adult ICU patients. Specifically, they enrolled patients presenting with metabolic acidosis and requiring vasopressor support. The treatment group received an infusion of sodium bicarbonate to target a normal pH level. In contrast, the control group received a matching placebo infusion. Furthermore, the researchers monitored key safety endpoints and kidney function up to day thirty.

Clinical Efficacy of Sodium Bicarbonate Therapy

Surprisingly, the trial demonstrated that the active infusion did not reduce major adverse kidney events. Indeed, the rate of persistent renal dysfunction remained similar between both study arms. Subsequently, data showed no significant differences in the overall thirty-day mortality rates. In addition, the duration of vasopressor-free days and ICU-free days did not differ. Thus, the rapid correction of acidemia did not translate into tangible clinical benefits for these patients.

Comparison and Clinical Implications

Previously, the open-label BICAR-ICU trial suggested potential renal benefits in patients with acute kidney injury. However, this newer, double-blind study provides stronger, higher-quality evidence against routine use. Consequently, clinicians should carefully consider the actual necessity of this intervention in severe shock. Moreover, unnecessary administration might lead to adverse effects like hypernatremia and metabolic alkalosis. Ultimately, physicians must focus on treating the underlying cause of metabolic acidosis first.

Frequently Asked Questions

Q1: Did sodium bicarbonate therapy reduce the need for renal replacement therapy in the SODa-BIC trial?

Indeed, the trial demonstrated that sodium bicarbonate therapy did not significantly reduce the rates of renal replacement therapy. Furthermore, the incidence of persistent kidney dysfunction remained similar between both treatment groups.

Q2: Is sodium bicarbonate therapy still recommended for all patients with metabolic acidosis?

Consequently, clinicians should not routinely prescribe this treatment for patients receiving vasopressors in the ICU. However, specific individuals with severe renal failure might still derive some benefit from this intervention.

References

1. undefined undefined et al. Sodium Bicarbonate for Critically Ill Adults with Metabolic Acidosis and Shock. N Engl J Med. 2026 Jun 12. doi: 10.1056/NEJMoa2600526. PMID: 42283370.
2. Jaber S, Paugam C, Futier E, et al. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018 Jul 7;392(10141):31-40. doi: 10.1016/S0140-6736(18)31080-8. PMID: 29910040.