Safety and efficacy of intravenous Carbicarb® in patients undergoing surgery: Comparison with sodium bicarbonate in the treatment of mild metabolic acidosis

Lactic acid is a marker of tissue ischemia but it also may accumulate without tissue hypoperfusion. In the latter circumstance, lactic acid accumulation may be an adaptive mechanism-a novel possibility quite in contrast to the traditional view of lactic acid as only a marker of tissue ischemia. Studies on the treatment of LA with sodium bicarbonate or other buffers fail to show consistent clinical benefit. Severe acidemia in the setting of LA is a particularly poorly studied area. In the settings of medication-induced LA, optimal treatment, apart from prompt cessation of the offending agent, is still unclear.

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“…Human studies have not shown superiority of any of the buffers as far as improving pH, 83,84 hemodynamics, or survival. 85 …”

Section: Treatment Of La and Use Of Other Buffersmentioning

confidence: 97%

Treatment of lactic acidosis: Appropriate confusion

Rachoin

Weisberg

McFadden

2010

Journal of Hospital Medicine

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“…Atmospheric equilibration has brought the pH to 9.35, which is less than that of sodium thiopentone (pH 10.4) [46] – a drug that is normally free of venous irritation. Similarly Carbicarb, a low CO 2TOT alternative to NaHCO 3 preparations [47], has a pH of 9.6 [48]. Thus, the pH of solution 2 may not preclude peripheral or more rapid central administration.…”

Section: Thinking About Fluids In Stewart's Termsmentioning

confidence: 99%

Untitled

Morgan

2004

Crit Care

114

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Stewart's quantitative physical chemical approach enables us to understand the acid-base properties of intravenous fluids. In Stewart's analysis, the three independent acid-base variables are partial CO 2 tension, the total concentration of nonvolatile weak acid (A TOT ), and the strong ion difference (SID). Raising and lowering A TOT while holding SID constant cause metabolic acidosis and alkalosis, respectively. Lowering and raising plasma SID while clamping A TOT cause metabolic acidosis and alkalosis, respectively. Fluid infusion causes acid-base effects by forcing extracellular SID and A TOT toward the SID and A TOT of the administered fluid. Thus, fluids with vastly differing pH can have the same acid-base effects. The stimulus is strongest when large volumes are administered, as in correction of hypovolaemia, acute normovolaemic haemodilution, and cardiopulmonary bypass. Zero SID crystalloids such as saline cause a 'dilutional' acidosis by lowering extracellular SID enough to overwhelm the metabolic alkalosis of A TOT dilution. A balanced crystalloid must reduce extracellular SID at a rate that precisely counteracts the A TOT dilutional alkalosis. Experimentally, the crystalloid SID required is 24 mEq/l. When organic anions such as L-lactate are added to fluids they can be regarded as weak ions that do not contribute to fluid SID, provided they are metabolized on infusion. With colloids the presence of A TOT is an additional consideration. Albumin and gelatin preparations contain A TOT , whereas starch preparations do not. Hextend is a hetastarch preparation balanced with L-lactate. It reduces or eliminates infusion related metabolic acidosis, may improve gastric mucosal blood flow, and increases survival in experimental endotoxaemia. Stored whole blood has a very high effective SID because of the added preservative. Large volume transfusion thus causes metabolic alkalosis after metabolism of contained citrate, a tendency that is reduced but not eliminated with packed red cells. Thus, Stewart's approach not only explains fluid induced acid-base phenomena but also provides a framework for the design of fluids for specific acid-base effects.

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“…In vivo studies in animals which have acute lactic acidosis revealed that Carbicarb improved systemic acid-base parameters, raised intracellular pH and improved cardiac function, whereas sodium bicarbonate did not improve cardiac function or improve intracellular pH (Bersin and Arieff, 1988). By contrast, Carbicarb, when administered to humans who had mild metabolic acidosis (serum [

{HCO}_{3}^{-}

] ≈ 20 mEq/L) failed to provide more benefit than sodium bicarbonate (Leung et al, 1994). Although, this human study had a very limited scope, as a consequence of this result, Carbicarb was never adopted in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acidified Blood Using Reduced Osmolarity Mixed-Base Solutions

Mason

Kraut

2016

Front. Physiol.

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We hypothesize that reduced osmolarity mixed-base (ROMB) solutions can potentially serve as customizable treatments for acidoses, going beyond standard solutions in clinical use, such as 1.0 M sodium bicarbonate. Through in silico quantitative modeling, by treating acidified canine blood using ROMB solutions, and by performing blood-gas and optical microscopy measurements in vitro, we demonstrate that ROMB solutions having a high proportion of a strong base, such as disodium carbonate or sodium hydroxide, can be effective in reducing carbon dioxide pressure PCO2 while raising pH and bicarbonate ion concentration without causing significant osmotic damage to red blood cells, which can occur during rapid administration of hypertonic solutions of weak bases. These results suggest that a ROMB solution, which is composed mostly of a strong base, could be administered in a safe and effective manner, when compared to a hypertonic solution of sodium bicarbonate. Because of the reduced osmolarity and the customizable content of strong base in ROMB solutions, this approach differs from prior approaches involving hypertonic solutions that only considered a single molar ratio of strong to weak base. Our calculations and measurements suggest that custom-tailored ROMB solutions merit consideration as potentially efficacious treatments for specific types of acidosis, particularly acute metabolic acidosis and acute respiratory acidosis.

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Safety and efficacy of intravenous Carbicarb® in patients undergoing surgery: Comparison with sodium bicarbonate in the treatment of mild metabolic acidosis

Cited by 42 publications

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Treatment of lactic acidosis: Appropriate confusion

Treatment of lactic acidosis: Appropriate confusion

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Treatment of Acidified Blood Using Reduced Osmolarity Mixed-Base Solutions

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