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. 2025 Jun 5;25(1):458.
doi: 10.1186/s12887-025-05815-1.

Sodium bicarbonate in treating lactic and non-lactic metabolic acidosis at different chloride levels: a retrospective study

Jian Wu #  1 , Ling Lai #  1 , Xiaoyan Xue  1 , Shuiyan Wu  2 , Huaqing Liu  3
Affiliations

Sodium bicarbonate in treating lactic and non-lactic metabolic acidosis at different chloride levels: a retrospective study

Jian Wu et al. BMC Pediatr. .

Abstract

Background: Sodium bicarbonate is commonly used to correct metabolic acidosis in pediatric patients, yet its efficacy remains controversial. This study aims to assess its effectiveness in treating non-lactic and lactic metabolic acidosis and its impact at various chloride levels.

Methods: A retrospective cohort study was conducted by screening pediatric patients diagnosed with metabolic acidosis from a paediatric intensive care database. Patients were categorized into two groups: lactate patients (lactate > 2.0 mmol/L) and non-lactate patients (lactate ≤ 2.0 mmol/L). The risk of death in patients who received sodium bicarbonate was assessed.

Results: Sodium bicarbonate treatment did not significantly affect in-hospital mortality in either overall lactate patients or non-lactate patients, with adjusted OR of 1.044 (95% CI: 0.829-1.315, p = 0.714) and 0.838 (95% CI: 0.548-1.281, p = 0.414), respectively. In lactate patients, those receiving sodium bicarbonate had a higher risk of in-hospital death when chloride was < 107 mmol/L (adjusted OR = 2.195, 95% CI: 1.536-3.135, p < 0.001), whereas the risk of in-hospital death decreased when chloride was ≥ 113 mmol/L (adjusted OR = 0.365, 95% CI: 0.217-0.614, p < 0.001). Similar findings were observed in non-lactate patients.

Conclusions: Sodium bicarbonate treatment does not improve the survival of pediatric patients with lactate or non-lactate metabolic acidosis. However, it can reduce the odds of mortality in pediatric patients with hyperchloremia, regardless of their lactate levels. Prospective studies are needed to further confirm these findings.

Keywords: Chloride; Lactate; Metabolic acidosis; Pediatric; Sodium bicarbonate.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Screening flow chart. LA, lactate ≥ 2 mmol/L; Non-LA, lactate < 2 mmol/L; SOB, sodium bicarbonate
Fig. 2
Fig. 2
Forest risk plots of death for patients who received sodium bicarbonate categorized by lactic and non-lactic metabolic acidosis
Fig. 3
Fig. 3
Forest risk plots of death for LA patients who received sodium bicarbonate categorized by chloride levels
Fig. 4
Fig. 4
Forest risk plots of death for Non-LA patients who received sodium bicarbonate categorized by chloride levels
See this image and copyright information in PMC

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