[Should metabolic acidosis be alkalinized?].
At present, the administration of bicarbonate for metabolic acidosis has become controversial with regard to the indications and the modalities of treatment. Scientific evidence of the therapeutic value of bicarbonate is still lacking. In the opposite, there is a strong evidence of its adverse effects, such a paradoxical acidosis, sodium load and over all a worsening of haemodynamic status. Other therapeutic measures are limited. They include the administration of Carbicarb which does not increase the CO2 content, haemodialysis with bicarbonate and/or hyperventilation. As for every therapeutic action, the treatment must rely on an interpretation of the pathophysiological mechanism, resulting in the definition of therapeutic goals. The amendment of acidosis is not always a therapeutic priority. In ketoacidosis for instance, the depth of acidosis is mainly related to the degree of dehydration, the treatment of which results in a normalization of pH.
Leverve
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Service d'Urgence et de Réanimation Médicale, Unité de Nutrition parentérale, CHU de Grenoble.
Guignier
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D000138:Acidosis / Q000378:metabolism* / Q000628:therapy; D000596:Amino Acids / Q000378:metabolism; D001639:Bicarbonates / Q000627:therapeutic use*; D050260:Carbohydrate Metabolism; D002254:Carbonates / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D006985:Hyperventilation / Q000503:physiopathology; D050356:Lipid Metabolism; D011522:Protons; D006435:Renal Dialysis; D012964:Sodium / Q000627:therapeutic use; D017693:Sodium Bicarbonate
D000596:Amino Acids; D001639:Bicarbonates; D002254:Carbonates; D004338:Drug Combinations; D011522:Protons; C046283:sodium bicarbonate, sodium carbonate drug combination; D017693:Sodium Bicarbonate; D012964:Sodium
Faut-il alcaliniser les acidoses métaboliques?