Urgent considerations
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Metabolic acidosis is not usually life-threatening unless extremes of pH are achieved (e.g., arterial pH <7.00). Many of the causes of metabolic acidosis are extremely serious. Prompt definitive diagnosis and treatment of the underlying condition is essential.
The potential benefit of giving sodium bicarbonate to raise extracellular pH in critically unwell patients is unclear.[10] Evidence from one phase 3 randomised controlled trial (RCT) suggested that sodium bicarbonate may improve 28-day survival in a subgroup of patients with severe metabolic acidosis and acute kidney injury.[11] A larger RCT, however, found that sodium bicarbonate infusion was not associated with lower 90-day all-cause mortality in patients with severe metabolic acidosis with moderate to severe acute kidney injury.[12] Further research is ongoing.[13]
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