Objectives: To critically discuss the treatment of metabolic acidosis and the main mechanisms of disease associated with this disorder; and to describe controversial aspects related to the risks and benefits of using sodium bicarbonate and other therapies. Other promising treatment alternatives have been proposed; however, the side effects and absence of controlled studies with pediatric populations translate into lack of evidence to support the routine use of such treatments.J Pediatr (Rio J). 2007;83(2 Suppl):S11-21: Acidosis/therapy, acidosis, lactic, diabetic ketoacidosis, sodium bicarbonate, child.