簡介：Lactic acidosis causes a decrease in serum bicarbonate concentration. Lactate is a metabolizable organic anion. That, when oxidized, will generate bicarbonate. The role of exogenous bicarbonate therapy in patients with lactic acidosis is controversial. Most of the experts believe that it is appropriate to use bicarbonate in acutely ill patients in profound lactic acidosis and acidemia (arterial pH less than 7.1). Such severe acidemia may produce hemodynamic instability as a result of reduced left ventricular contractility, and impaired responsiveness to catecholamine. In my opinion, bicarbonate therapy should be initiated when acidosis has generated severe acidemia (ie, pH<7.2). In the BICARICU study, patients with less severe acidemia (eg, pH 7.1 to 7.2) and severe acute kidney injury, bicarbonate therapy can potentially prevent the need for dialysis and may improve survival. And, the goal is to raise the pH above 7.3. Rapid infusions of sodium bicarbonate may increase the partial pressure of carbon dioxide (PCO2), accelerate the production of lactate, lower the ionized calcium, expand the extracellular space, and raise the serum sodium concentration. My talk will start from a case with HHS and sepsis from liver abscess. He also take Metformin for the sugar control. On the way to the CT scan with the enhancement, we will discuss more about the safety and indications for using sodium bicarbonate in ER.