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[Comment] Sodium bicarbonate for severe metabolic acidaemia

Severe metabolic acidaemia (blood pH ≤7·20) is associated with impaired haemodynamics and increased mortality in critically ill patients.1 Administration of sodium bicarbonate can increase blood pH, but its ability to improve haemodynamics and reduce mortality remains unproven.2–6 Sodium bicarbonate has been shown to increase blood pH levels but did not increase cardiac output compared with saline when examined at 30 min or 60 min after infusion,3,6 and did not reduce mortality in studies involving cohorts of 34–150 individuals with severe acidaemia.