{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T11:33:52Z","timestamp":1791977632293,"version":"4.4.0"},"reference-count":180,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T00:00:00Z","timestamp":1734739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sodium bicarbonate has been used in the treatment of different pathologies, such as hyperkalemia, cardiac arrest, tricyclic antidepressant toxicity, aspirin toxicity, acute acidosis, lactic acidosis, diabetic ketoacidosis, rhabdomyolysis, and adrenergic receptors\u2019 resistance to catecholamine in patients with shock. An ongoing debate about bicarbonate\u2019s efficacy and potential harm has been raised for decades because of the lack of evidence supporting its potential efficacy. Despite the guidelines\u2019 restrictions, sodium bicarbonate has been overused in clinical practice. The overuse of sodium bicarbonate could be because of the desire to correct the arterial blood gas parameters rapidly instead of achieving homeostasis by treating the cause of the metabolic acidosis. Moreover, it is believed that sodium bicarbonate may reverse acidosis-induced myocardial depression, hemodynamic instability, ventricular arrhythmias, impaired cellular energy production, resistance to catecholamines, altered metabolism, enzyme suppression, immune dysfunction, and ineffective oxygen delivery. On the other hand, it is crucial to pay attention to the potential harm that could be caused by excessive sodium bicarbonate administration. Sodium bicarbonate may cause paradoxical respiratory acidosis, intracellular acidosis, hypokalemia, hypocalcemia, alkalosis, impaired oxygen delivery, cerebrospinal fluid acidosis, and neurologic dysfunction. In this review, we discuss the pathophysiology of sodium bicarbonate-induced adverse effects and potential benefits. We also review the most recent clinical trials, observational studies, and guidelines discussing the use of sodium bicarbonate in different pathologies.<\/jats:p>","DOI":"10.3390\/jcm13247822","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T10:58:55Z","timestamp":1734951535000},"page":"7822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4219-3659","authenticated-orcid":false,"given":"Akram M.","family":"Eraky","sequence":"first","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"},{"name":"Graduate Medical Education, Kansas City University, Kansas City, MO 64106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9488-2851","authenticated-orcid":false,"given":"Yashwanth","family":"Yerramalla","sequence":"additional","affiliation":[{"name":"Pulmonology and Critical Care Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Khan","sequence":"additional","affiliation":[{"name":"Pulmonology and Critical Care Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Mokhtar","sequence":"additional","affiliation":[{"name":"Pulmonology and Critical Care Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alisha","family":"Wright","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walaa","family":"Alsabbagh","sequence":"additional","affiliation":[{"name":"Internal Medicine, Northern General Hospital, Sheffield S5 7AU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7746-6667","authenticated-orcid":false,"given":"Kevin","family":"Franco Valle","sequence":"additional","affiliation":[{"name":"Anesthesiology Department, University of Michigan Medical School, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3113-2307","authenticated-orcid":false,"given":"Mina","family":"Haleem","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Department of Clinical and Experimental Internal Medicine, Medical Research Institute, Alexandria University, Alexandria 5422031, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad","family":"Boulware","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13613-019-0563-2","article-title":"Diagnosis and Management of Metabolic Acidosis: Guidelines from a French Expert Panel","volume":"9","author":"Jung","year":"2019","journal-title":"Ann. 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