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

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.