It would be interesting to see if there was a difference based on the delta/delta value. I would expect patients with a higher contribution of the normal gap acidosis to have a greater benefit from the bicarb as this is coming primarily from the AKI. It may be that patients with a greater contribution of the lactic acidosis have worse outcomes.
I think it is one of the most important studies of the year.
Of course, the 90-day mortality endpoint is BS because acidosis and AKI would be treated anyway in both groups.
However, it was highly plausible that loading the patient with bicarbonate would delay or obviate dialysis, as long as the patient urinates.
My take is that you don’t need to replicate their bicarb dilution. It is a first-order and dose-dependent effect. Give as necessary.
Would you concentrate the bicarb at all? What preparation would be used in Brazil?
We have Molar (8.4%) sodium bicarbonate presented in 250 mL and 10 mL vials. It certainly applies to most hospitals in the country.
(I think BICARICU used half-molar (4.2%))
I think 8.4% is concentrated enough
It would be interesting to see if there was a difference based on the delta/delta value. I would expect patients with a higher contribution of the normal gap acidosis to have a greater benefit from the bicarb as this is coming primarily from the AKI. It may be that patients with a greater contribution of the lactic acidosis have worse outcomes.
Great point. No doubt a heterogeneous group with regard to type and etiology of acidosis.