The Janus faces of bicarbonate therapy in the ICU

  • Boris Jung
  • Samir JaberEmail author
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Metabolic acidosis is characterized by a primary reduction in plasma bicarbonate concentration below 20 mmol/L in the Henderson–Hasselbalch method and with either an imbalance between strong plasma cations concentration compared to the strong anions concentration (decreasing thus the strong ion difference) and/or an excess in non-volatile weak acids in the Stewart–Fencl method [1, 2]. Acidemia is the term used if the plasma pH is equal to or below 7.38, acidemia being described as severe when the pH is equal to or below 7.20 [3, 4]. Metabolic acidemia can be associated with organ failure, in particular respiratory failure (increased ventilatory demand) and cardiovascular failure (arterial vasodilation, decreases in cardiac inotropism and cardiac output, ventricular arrhythmia) [1, 5, 6]. Metabolic acidemia is observed in 14–42% of the critically ill patients [7] and, when acidemia is severe (pH < 7.20) and persists, is associated with 50–60% mortality in the Intensive...


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Conflicts of interest

Pr. Jaber reports receiving consulting fees from Drager, Fisher & Paykel and Fresenius.


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© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Département de Médecine Intensive et RéanimationCHU MontpellierMontpellierFrance
  2. 2.PhyMedExp, INSERM U1046, CNRS, UMR 9214Centre Hospitalier Universitaire Montpellier, University of MontpellierMontpellier Cedex 5France
  3. 3.Intensive Care Unit, Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching HospitalCentre Hospitalier Universitaire Montpellier, University MontpellierMontpellier Cedex 5France

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