Therapeutic target
- Restoration of a physiological pH value
Therapy recommendations
- Treatment of the underlying condition:
- Diabetic ketoacidosis: adequate volume replacement, sufficient insulin administration (i.v.) until ketone body production is stopped and, at the same time, substitution of the frequently accompanying potassium deficit
- Intoxications ((poisonings):
- Methanol or ethylene glycol/glycols (dialcohols (divalent alcohols) derived from ethylene glycol): Fomepizole or ethanol to competitively block alcohol dehydrogenase (catalyzes the chemical conversion of alcohols to the corresponding aldehydes or ketones and the corresponding reverse reaction); dialysis (kidney wash) if necessary.
- Salicylates: activated charcoal, alkali addition (e.g., citrates); also dialysis (kidney wash) if necessary.
- Substitution with sodium bicarbonate (at pH < 7.15); correction only to pH > 7.2, do not completely balance!
- See also under “Further therapy“.
Further notes
- The BiCARB study, commissioned by the UK National Institute for Health Research (NIHR), of 300 patients ≥ 60 years of age with advanced CKD/chronic renal failure (eGFR < 30 ml/min/1.73 m2) failed to demonstrate that sodium bicarbonate versus placebo therapy had benefits for any of the endpoints. Patients on hemodialysis (blood washing) were excluded from the study. Physical function at 12 months, as measured by the Short Physical Performance Battery (SPPB), was the primary endpoint. Secondary endpoints included quality of life, renal function, biomarkers, and treatment-associated adverse events.
