SODium BICarbonate for Metabolic Acidosis in the ICU (SODa-BIC)
Metabolic Acidosis, Shock
About this trial
This is an interventional treatment trial for Metabolic Acidosis focused on measuring Sodium bicarbonate, Metabolic acidosis, Shock, Clinical trial
Eligibility Criteria
Inclusion Criteria: All the diagnostic criteria of metabolic acidosis below have to be fulfilled within the last 2 hours before randomisation (pH, PaCO2 and BE from the same blood gas), and a vasopressor is being infused continuously at the time of randomization. Adults (≥ 18 years); Receiving a continuous infusion of a vasopressor to maintain mean arterial pressure > 65 mmHg (or a mean arterial pressure target set by the treating clinician); A dedicated intravenous line (central or peripheral) is available (or insertion of such a line is planned within the next hour); and Metabolic acidosis, defined as: pH < 7.30; and BE ≤ -4 mEq/L; and PaCO2 ≤ 45 mmHg. Exclusion Criteria: Fulfilled all eligibility criteria greater than 48 hours ago; or Suspected clinically significant digestive or urinary tract loss of sodium bicarbonate (e.g., diarrhoea, ileostomy losses, renal tubular acidosis, or drainage of pancreatic or bile duct); or DKA; or Estimated glomerular filtration rate (eGFR) < 30 mL/min due to chronic kidney disease; or Currently receiving sodium bicarbonate at the moment of randomisation (doses of sodium bicarbonate prior to randomisation are allowed); or Currently receiving RRT (acute or chronic) or planned to start RRT in the next 3 hours (according to the treating clinical team); or Severe dysnatraemia (serum Na ≥ 155 mEq/L or < 120 mEq/L); or Hypokalaemia (serum K < 2.5 mEq/L); or Pulmonary oedema with PaO2 / FiO2 < 100; or Hypocalcaemia (iCa < 0.8mmol/L); or Patients admitted to the ICU after a drug overdose or intoxication (including alcohol intoxication); or Pregnancy or breastfeeding; or Death is deemed to be inevitable as a result of the current acute illness and either the treating clinician, the patient or the substitute decision maker are not committed to full active treatment; or Patients with a life expectancy < 30 days due to a chronic or underlying medical condition; or Considered to be at high risk of cerebral oedema by the treating clinician (e.g. traumatic brain injury or acute brain disease); or Clinician believes that being enrolled in intervention or control arm is not in the best interest of the patient; or Previous enrolment in this study.
Sites / Locations
- The Austin Hospital
- The Alfred HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Sodium bicarbonate
5% dextrose
Sodium bicarbonate 8.4% (1000 mEq/L) will be diluted in a D5W solution (500 mL bag). For preparation, 300 mL of D5W will be removed and 300 mL of sodium bicarbonate 8.4% added to prepare the bicarbonate solution in a total volume of 500 mL (final concentration: 600 mEq/L).
Standard 500 mL bag of D5W.