Sodium Bicarbonate (Buffering)

BACKGROUND: Sodium bicarbonate (SB) supplementation may enhance short-term, high-intensity exercise performance through improved extracellular buffering capacity, but its effect on continuous running performance has not been systematically evaluated. We conducted a systematic review with meta-analysis of randomized, double-blind, placebo-controlled trials examining the effects of oral single-dose SB supplementation on continuous running performance. METHODS: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for eligible trials published through 31 December 2024. The primary outcome was performance on a continuous running test. Secondary outcomes included gastrointestinal (GI) symptoms and GI-associated study withdrawal rates. Running performance was analyzed using random-effects meta-analysis with adjustment for GI-related study withdrawals using intent-to-treat methods and publication bias using the trim-and-fill method. Treatment effects were reported using the standardized mean difference (SMD) statistic where 0.00-0.19 represents negligible benefit, 0.20-0.49 small benefit, 0.50-0.79 medium benefit, and ≥ 0.80 large benefit. We used univariable meta-regression to examine factors associated with treatment effect magnitude. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS: Among 11 studies with 126 participants, all used a cross-over design. Most (84%) subjects were male, SB dose was typically 0.3 g/kg, and performance test durations ranged from 1 to 30 minutes (median: 4 minutes). GI symptoms occurred more frequently with SB than placebo (29.5% vs. 2.6%; odds ratio = 5.9; p = 0.003; low certainty), as did GI-related study withdrawal (8.7% vs. 1.6%; odds ratio = 2.9; p = 0.049; moderate certainty). After adjusting for GI-related study withdrawal and publication bias, the treatment effect of SB was negligible and not statistically significant (SMD = 0.18; 95% CI: -0.01, 0.36; p = 0.06; I2 = 0%; moderate certainty). In meta-regression, male sex (p = 0.03) and higher body mass (p = 0.04) were associated with greater SB performance benefits

This systematic review and meta-analysis evaluated the effects of sodium bicarbonate (NaHCO₃) supplementation on 200 m time trial performance and physiological responses in swimmers, following PRISMA guidelines. A comprehensive search across five databases identified eligible randomized controlled trials comparing NaHCO₃ with placebo. Outcomes were 200 m time, blood bicarbonate, blood lactate, and blood pH. Results showed significant increases in blood bicarbonate (SMD = 1.09, 95% CI = 0.38 to 1.79, P<0.01), blood lactate (SMD = 0.76, 95% CI = 0.24 to 1.29, P<0.01) and blood pH (SMD = 1.02, 95% CI = 0.33 to 1.71, P<0.01), but no effect on 200 m time (SMD = 0.26, 95% CI -0.58 to 1.10). These findings suggest NaHCO₃ enhances certain physiological responses but does not improve 200 m performance, though data limitations require cautious interpretation.

Nutritional ergogenic aids (NEAs) are substances included within the group of sports supplements. Although they are widely consumed by athletes, evidence-based analysis is required to support training outcomes or competitive performance in specific disciplines. Combat sports have a predominant use of anaerobic metabolism as a source of energy, reaching peak exertion or sustained effort for very short periods of time. In this context, the use of certain NEAs could help athletes to improve their performance in those specific combat skills (i.e., the number of attacks, throws and hits; jump height; and grip strength, among others) as well as in general physical aspects (time to exhaustion [TTE], power, fatigue perception, heart rate, use of anaerobic metabolism, etc.). Medline/PubMed, Scopus and EBSCO were searched from their inception to May 2022 for randomised controlled trials (RCTs). Out of 677 articles found, 55 met the predefined inclusion criteria. Among all the studied NEAs, caffeine (5-10 mg/kg) showed strong evidence for its use in combat sports to enhance the use of glycolytic pathways for energy production during high-intensity actions due to a greater production of and tolerance to blood lactate levels. In this regard, abilities including the number of attacks, reaction time, handgrip strength, power and TTE, among others, were improved. Buffering supplements such as sodium bicarbonate, sodium citrate and beta-alanine may have a promising role in high and intermittent exertion during combat, but more studies are needed in grappling combat sports to confirm their efficacy during sustained isometric exertion. Other NEAs, including creatine, beetroot juice or glycerol, need further investigation to strengthen the evidence for performance enhancement in combat sports. Caffeine is the only NEA that has shown strong evidence for performance enhancement in combat sports.

PURPOSE OF REVIEW: To verify the effects of sodium bicarbonate (NaHCO3) supplementation on biochemical and physical measurements of combat sports athletes. RECENT FINDINGS: A systematic review of articles indexed in three databases (PubMed, CAPES journal, and Google Scholar) was carried out until October 2020, using descriptors related to NaHCO3 supplementation in combat sports. First, 38 articles were identified. Next, eight articles were selected through the inclusion and exclusion criteria. The methodological quality of the articles was assessed using the Physiotherapy Evidence Database (PEDro) scale (8 and 9 points). Blood lactate, rating of perceived exertion, Special Judo Fitness Test, Dummy throw, and mean and peak powers for Wingate were evaluated. Random effects meta-analysis was used, the effect size was adjusted by corrected Hedges' g, and the heterogeneity is explored by I2. The results were obtained through weighted average and 95% CI, and the significance limit was set as p < 0.05. NaHCO3 supplementation had a significant effect on increasing blood lactate (p = 0.006) of the athletes studied. However, the performance measures (rating of perceived exertion, power, and specific performance) did not show a significant difference (p ˂ 0.05). In conclusion, NaHCO3 supplementation causes a significant increase in blood lactate, indicating an ergogenic effect on buffer, which can delay the onset of fatigue and contribute to the performance of combat sports athletes. New experimental studies need to be published that assess the effect of acute and chronic NaHCO3 supplementation in specific combat sports tests and in women. © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

BACKGROUND: Extracellular buffering supplements [sodium bicarbonate (SB), sodium citrate (SC), sodium/calcium lactate (SL/CL)] are ergogenic supplements, although questions remain about factors which may modify their effect. OBJECTIVE: To quantify the main effect of extracellular buffering agents on exercise outcomes, and to investigate the influence of potential moderators on this effect using a systematic review and meta-analytic approach. METHODS: This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Three databases were searched for articles that were screened according to inclusion/exclusion criteria. Bayesian hierarchical meta-analysis and meta-regression models were used to investigate pooled effects of supplementation and moderating effects of a range of factors on exercise and biomarker responses. RESULTS: 189 articles with 2019 participants were included, 158 involving SB supplementation, 30 with SC, and seven with CL/SL; four studies provided a combination of buffering supplements together. Supplementation led to a mean estimated increase in blood bicarbonate of + 5.2 mmol L-1 (95% credible interval (CrI) 4.7-5.7). The meta-analysis models identified a positive overall effect of supplementation on exercise capacity and performance compared to placebo [ES0.5 = 0.17 (95% CrI 0.12-0.21)] with potential moderating effects of exercise type and duration, training status and when the exercise test was performed following prior exercise. The greatest ergogenic effects were shown for exercise durations of 0.5-10 min [ES0.5 = 0.18 (0.13-0.24)] and > 10 min [ES0.5 = 0.22 (0.10-0.33)]. Evidence of greater effects on exercise were obtained when blood bicarbonate increases were medium (4-6 mmol L-1) and large (> 6 mmol L-1) compared with small (≤ 4 mmol L-1) [βSmall:Medium = 0.16 (95% CrI 0.02-0.32), βSmall:Large = 0.13 (95% CrI - 0.03 to 0.29)]. SB (192 outcomes) was more effective for performance compared to SC (39 outcomes) [βSC:SB = 0.10 (95% CrI - 0.02 to 0.22)]. CONCLUSIONS: Extracellular buffering supplements generate large increases in blood bicarbonate concentration leading to positive ove

BACKGROUND: The effects of sodium bicarbonate (NaHCO3) on anaerobic and aerobic capacity are commonly acknowledged as unclear due to the contrasting evidence thus, the present study analyzes the contribution of NaHCO3 to energy metabolism during exercise. METHODS: Following a search through five databases, 17 studies were found to meet the inclusion criteria. Meta-analyses of standardized mean differences (SMDs) were performed using a random-effects model to determine the effects of NaHCO3 supplementation on energy metabolism. Subgroup meta-analyses were conducted for the anaerobic-based exercise (assessed by changes in pH, bicarbonate ion [HCO3-], base excess [BE] and blood lactate [BLa]) vs. aerobic-based exercise (assessed by changes in oxygen uptake [VO2], carbon dioxide production [VCO2], partial pressure of oxygen [PO2] and partial pressure of carbon dioxide [PCO2]). RESULTS: The meta-analysis indicated that NaHCO3 ingestion improves pH (SMD = 1.38, 95% CI: 0.97 to 1.79, P < 0.001; I2 = 69%), HCO3- (SMD = 1.63, 95% CI: 1.10 to 2.17, P < 0.001; I2 = 80%), BE (SMD = 1.67, 95% CI: 1.16 to 2.19, P < 0.001, I2 = 77%), BLa (SMD = 0.72, 95% CI: 0.34 to 1.11, P < 0.001, I2 = 68%) and PCO2 (SMD = 0.51, 95% CI: 0.13 to 0.90, P = 0.009, I2 = 0%) but there were no differences between VO2, VCO2 and PO2 compared with the placebo condition. CONCLUSIONS: This meta-analysis has found that the anaerobic metabolism system (AnMS), especially the glycolytic but not the oxidative system during exercise is affected by ingestion of NaHCO3. The ideal way is to ingest it is in a gelatin capsule in the acute mode and to use a dose of 0.3 g•kg- 1 body mass of NaHCO3 90 min before the exercise in which energy is supplied by the glycolytic system.

ABSTRACTSodium bicarbonate (SB) is considered an effective ergogenic supplement for improving high-intensity exercise capacity and performance, although recent data suggests that women may be less amenable to its ergogenic effects than men. Currently, an apparent paucity of data on women means no consensus exists on whether women benefit from SB supplementation. The aim of the current study was to quantify the proportion of the published literature on SB supplementation that includes women, and to synthesise the evidence regarding its effects on blood bicarbonate and exercise performance in women by performing a systematic review and meta-analysis. Electronic searches of the literature were undertaken using three databases (MEDLINE, Embase, SPORTDiscus) to identify relevant articles. All meta-analyses were performed within a Bayesian framework. A total of 149 SB articles were identified, 11 of which contained individual group data for women. Results indicated a pooled blood bicarbonate increase of 7.4 [95%CrI: 4.2-10.4 mmol·L-1] following supplementation and a pooled standardised exercise effect size of 0.37 [95%CrI: -0.06-0.92]. The SB literature is skewed, with only 20% (30 studies) of studies employing female participants, of which only 11 studies (7.4%) provided group analyses exclusively in women. Despite the small amount of available data, results are consistent in showing that SB supplementation in women leads to large changes in blood bicarbonate and that there is strong evidence for a positive ergogenic effect on exercise performance that is likely to be small to medium in magnitude.HighlightsThis study aimed to quantify the proportion of the published literature on sodium bicarbonate supplementation that includes women and to synthesise the evidence regarding its ergogenic effect on women, using a systematic review and meta-analytic approach.The sodium bicarbonate literature is skewed, with only 30 studies (20%) employing female participants, of which only 11 studies (7.4%) provided group analyses exclusively in women.Despite the small amount of available data, results are consistent in showing that sodium bicarbonate supplementation in women leads to

BACKGROUND AND OBJECTIVES: Metabolic acidosis is associated with progression of CKD and has significant adverse effects on muscle and bone. A systematic review and meta-analysis was conducted to evaluate the benefits and risks of metabolic acidosis treatment with oral alkali supplementation or a reduction of dietary acid intake in those with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: MEDLINE, Embase, and Cochrane CENTRAL were searched for relevant trials in patients with stage 3-5 CKD and metabolic acidosis (<22 mEq/L) or low-normal serum bicarbonate (22-24 mEq/L). Data were pooled in a meta-analysis with results expressed as weighted mean difference for continuous outcomes and relative risk for categorical outcomes with 95% confidence intervals (95% CIs), using a random effects model. Study quality and strength of evidence were assessed using Cochrane risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS: Fourteen clinical trials were included (n=1394 participants). Treatment of metabolic acidosis with oral alkali supplementation or a reduction of dietary acid intake increased serum bicarbonate levels (14 studies, 1378 patients, mean difference 3.33 mEq/L, 95% CI, 2.37 to 4.29) and resulted in a slower decline in eGFR (13 studies, 1329 patients, mean difference -3.28 ml/min per 1.73 m2, 95% CI, -4.42 to -2.14; moderate certainty) and a reduction in urinary albumin excretion (very-low certainty), along with a reduction in the risk of progression to ESKD (relative risk, 0.32; 95% CI, 0.18 to 0.56; low certainty). Oral alkali supplementation was associated with worsening hypertension or the requirement for increased antihypertensive therapy (very-low certainty). CONCLUSIONS: Low-to-moderate certainty evidence suggest that oral alkali supplementation or a reduction in dietary acid intake may slow the rate of kidney function decline and potentially reduce the risk of ESKD in patients with CKD and metabolic acidosis.

INTRODUCTION: Background: It is unclear whether hyperhydration induced via glycerol, sodium bicarbonate or a combination of the two is most effective. Aim: This study evaluated the effects of glycerol-, sodium bicarbonate-, and glycerol + sodium bicarbonate-induced hyperhydration on measures of fluid retention, blood buffering capacity, and gastrointestinal symptoms at rest, in comparison to a fluid-only control. METHODS: Eleven healthy participants (six male) completed four trials (randomised, crossover design). Treatments consisted of glycerol-(G) = 1.0 g·kg-1 body mass glycerol; sodium bicarbonate-(SB) = 0.3 g·kg-1 body mass sodium bicarbonate; and combined glycerol and sodium bicarbonate supplementation-(G + SB) = 1.0 g·kg-1 body mass glycerol + 0.3 g·kg-1 body mass sodium bicarbonate; and a fluid only control-(CON) = 25 mL·kg-1 body mass artificially sweetened water. At baseline and at 20 min intervals for 180 min, urine samples were collected and analysed for volume, colour, and specific gravity, and gastrointestinal symptoms and body mass were quantified. At 60 min intervals, capillary blood was analysed for pH, blood bicarbonate concentration and plasma volume change. RESULTS: Compared to CON, fluid retention was significantly higher with G + SB from 120-180 min, SB from 120-140 min, and G from 160-180 min (p < 0.05), and accumulated urine volume was significantly lower with G + SB from 100-180 min, SB from 120-180 min, and G from 140-180 min (p < 0.05). There were no significant differences in fluid retention between G + SB, SB or G at any time point (p > 0.05). Compared to G and CON, blood pH and blood bicarbonate concentration was significantly higher with G + SB and SB from 60-180 min (p < 0.05). CONCLUSIONS: Fluid retention improved in G, SB and G + SB compared to CON, although there were no additive effects with G + SB compared to SB or G. Buffering capacity was significantly higher with SB and G + SB compared to G and CON. Minimal GI symptoms were induced by G, SB, G + SB and CON. Copyright: © 2026 Patrick et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,

Objectives: This study assessed the influence of oral and topical sodium bicarbonate (SB) on recovery and soccer-specific performance after exercise-induced muscle damage (EIMD). Methods: In a randomized, double-blind, placebo-controlled, parallel group design, 24 soccer players were allocated to oral SB, topical SB (PR Lotion, Momentous), or placebo (PLA) (n = 8 per condition) and attended six laboratory sessions: (i) familiarization, (ii) baseline measures, and (iii) four experimental trials on consecutive days. Muscle damage was induced on day 1 using 40 × 15 m sprints, after which either 0.3 g·kg-1 body mass (BM) SB (SB-ORAL), 0.9036 g·kg-1 BM PR Lotion (SB-LOTION), or an equivalent PLA was given. Recovery outcomes were measured post-EIMD, 1 d, 2 d, and 3 d post (day 1-4). Soccer-specific performance was repeated 3 d post, with supplements administered again 2 h pre-exercise. Recovery measures included muscle soreness, vertical jump height, and maximal voluntary isometric contraction. Illinois agility test (IAT), 8 × 25 m repeated sprints, and Yo-Yo Intermittent Recovery Test Level 2 (Yo-Yo IR2) were assessed as soccer-specific performance. Results: Neither SB-ORAL nor SB-LOTION accelerated indices of recovery but decline in soccer-specific performance from baseline to 3 d post was attenuated for SB-ORAL, with significant effects for IAT (p = 0.032, g = 1.69) and Yo-Yo IR2 (p = 0.026, g = 1.61) compared with PLA. Conclusions: SB did not accelerate recovery following EIMD but prescribing oral SB before subsequent exercise might rescue key performance indicators. These findings offer implications for practitioners working with soccer players during periods where full recovery is not achieved.

Purpose: We evaluated the feasibility of individualized sodium bicarbonate (NaHCO3) supplementation and its physiological effects on simulated artistic swimming duet performance, including blood buffering responses, perceived exertion, gastrointestinal (GI) tolerance, and performance scores. Methods: Seventeen (n = 17) elite adolescent female artistic swimmers completed an initial trial to determine individual time-to-peak blood bicarbonate concentration (Part 1). Subsequently, a subset (n = 7) completed a randomized, double-blind, crossover intervention (Part 2), performing competition duet routines (4 min) after ingesting either 0.3 g/kg NaHCO3 or a placebo timed to their individual alkalosis peak. Blood gas and lactate samples were taken pre- and post-performance. Performance was scored by blinded FINA adjudicators. GI discomfort was assessed before and after each routine. Results: Peak blood bicarbonate occurred at 52 ± 9 min post-ingestion, with a mean increase of 6.7 ± 1.8 mmol/L (g = 5.03). In Part 2 (n = 7), NaHCO3 significantly elevated pre- and post-performance pH (7.46 ± 0.02 vs. 7.37 ± 0.01; 7.34 ± 0.02 vs. 7.26 ± 0.03), HCO3- (29.5 ± 0.9 vs. 22.4 ± 0.4 mmol/L; 21.5 ± 1.2 vs. 15.7 ± 1.5 mmol/L), and base excess (5.9 ± 0.6 vs. -2.9 ± 0.5 mmol/L; -4.3 ± 0.8 vs. -10.3 ± 1.1 mmol/L) compared to the placebo (all p < 0.05, g = 3.99-14.93). Post-performance lactate was higher (9.3 ± 1.0 vs. 8.4 ± 0.9 mmol/L, g = 0.89), while rating of perceived exertion (RPE) was lower (12.9 ± 0.7 vs. 14.4 ± 0.7, p < 0.05, g = -2.14). Propulsion improved (6.66 ± 0.16 vs. 6.52 ± 0.20, g = 0.85), with no change in execution. Mild gastrointestinal symptoms were transiently elevated with NaHCO3. Conclusions: Individualized NaHCO3 dosing is a feasible and effective ergogenic strategy for artistic swimmers, enhancing systemic alkalosis and perceptual tolerance while preserving technical execution. These findings support the sport-specific integration of NaHCO3 to optimize anaerobic performance elements in high-level artistic swimming.

PURPOSE: This study compared the ingestion of a matched dose (0.3 g·kg-1 BM) of enteric-coated sodium bicarbonate (SB), sodium citrate (SC), and both combined (SBC) on high-intensity exercise performance using a time-to-peak ingestion strategy. METHODS: Ten trained female CrossFit athletes completed four 6-km cycling time trials after consuming either SB, SC, SBC, or a placebo (PLA) in enteric-coated capsules. Blood acid-base balance was measured preingestion, preexercise, and postexercise. RESULTS: Preexercise blood [HCO3-] was significantly higher in the SB trial compared with the SC (+2.3 [1.8] mmol·L-1, P = .003, g = 1.2) and PLA (+6.5 [1.1 mmol·L-1, P < .0005, g = 2.5) trial. Performance time was faster with SB trials when compared with SC (-11.6 [8.0] s, P = .01), SBC (-17.2 [9.1] s, P = .001), and PLA (-21.5 [14.5] s, P = .007), with no significant difference between SC (mean difference [MD] = 9.9 s, P = .94) and SBC (MD = 4.3, P = 1.0) when compared with PLA. Blood lactate concentration was significantly greater in the SB trial compared with the placebo (MD = 2.4 [2.8] mmol·L-1, P < .001). Preexercise gastrointestinal symptom scores were higher with SB when compared to PLA (MD = 2.4 [3.2] arbitrary units, P = .04) and SC (MD = 2.2 [2.7], P = .032). CONCLUSION: Ingestion of 0.3 g·kg-1 BM of SB improved extracellular buffering capacity when compared with SC and PLA, allowing exercise performance improvements.

The consequences of chronic subclinical metabolic acidosis, characterized by an increase in single nephron ammonium generation, contribute to the progression of chronic kidney disease (CKD). Therefore, sodium bicarbonate (NaHCO₃) supplementation in CKD with normal serum bicarbonate patients may reduce kidney fibrosis and slow CKD progression. This study aimed to evaluate the impact of high-dose NaHCO₃ supplementation on urinary transforming growth factor-beta (TGF-β), a biomarker of kidney fibrosis, in non-diabetic CKD patients with normal serum bicarbonate levels. We conducted a single-center, randomized, open-label controlled trial in patients with non-diabetic CKD stage 3-4 and normal serum bicarbonate (22-26 mEq/L). Participants were randomized to receive high-dose NaHCO₃ (0.8 mEq/kg/day) or standard care for 12 weeks. The primary outcome was the change in urinary TGF-β-to-creatinine ratio from baseline. Secondary outcomes included changes in urinary albumin-to-creatinine ratio (UACR), urine pH, serum electrolytes, blood pressure, and adverse events. A total of 64 participants were randomized (NaHCO₃ group: n = 32; control group: n = 32). There was no significant difference in the percentage change of urinary TGF-β (NaHCO₃: -1.86% vs. control: 5.75%; p = 0.477). However, the NaHCO₃ group demonstrated a significant increase in urine pH mean difference (0.56; 95% CI: 0.3,0.82 vs. 0,95% CI -0.24,0.24; p = 0.002) compared to the control group. Similarly, no significant differences were observed in UACR, serum electrolytes, blood pressure, or body weight between groups. No serious adverse events were reported. High-dose NaHCO₃ supplementation in non-diabetic CKD patients with normal serum bicarbonate levels did not significantly reduce urinary TGF-β over 12 weeks but effectively increased urine pH without adverse effects. These findings suggest that NaHCO₃ is safe; however, its role in modulating profibrotic biomarkers in CKD requires further investigation. Longer-term studies and alternative alkali therapies should be explored to determine the optimal strategies for preserving kidney function in this population.Clinical trial registration: TCTR20240817007 (17/08

PURPOSE: Sodium bicarbonate Ringer's solution (BRS) is an intravenous fluid that does not rely on hepatic or renal metabolism. It contains bicarbonate ions (HCO3 -) and lacks lactate ions. This study hypothesizes that BRS is more effective in maintaining acid-base balance during prolonged open abdominal surgeries. The aim is to investigate the effects of sodium bicarbonate Ringer's solution on lactate metabolism, acid-base balance, and clinical outcomes in patients undergoing extended-duration open abdominal surgery, with the objective of refining fluid replacement strategies for this patient population. PATIENTS AND METHODS: A multicenter randomized controlled trial was conducted involving 112 patients undergoing open abdominal surgery. Participants were randomly assigned to either the BRS group (n=55) or the lactated Ringer's solution (LRS) group (n=57). The primary outcome was the incidence of postoperative hyperlactacidemia, while secondary outcomes included serum lactate (Lac), pH, base excess (BE), buffered base (BB), bicarbonate (HCO3 -), blood glucose (Glu), electrolytes, postoperative liver and kidney function, and postoperative complications. Linear regression analysis was performed to identify factors influencing lactate concentration. RESULTS: The incidence of hyperlactic acidemia was lower in Group A compared to Group B (9.1% vs 19.3%, P = 0.177), although the difference did not reach statistical significance. No significant differences were observed in lactate (Lac), pH, base excess (BE), bicarbonate (BB), HCO₃⁻, glucose (Glu), or electrolytes between the two groups at any time point (P time < 0.001, P group > 0.05, P time * group > 0.05). Linear regression analysis revealed that diabetes, hypotension and blood loss were significant factors influencing blood lactate concentration (R² = 0.349, P < 0.001). CONCLUSION: Sodium bicarbonate Ringer's solution and lactate Ringer's solution are both safe options for fluid replacement during long-term open abdominal surgeries. There is no significant difference observed in perioperative lactate levels, acid-base balance, or clinical postoperative outcomes between the two solutions. © 2025 Zhou et al.

OBJECTIVE: We aimed to compare the effect of 0.9% sodium chloride (SC) versus ringer's lactate (RL) in the resolution of diabetic ketoacidosis (DKA). DESIGN: Open randomized trial. SETTING: A medical ICU from November 2022 to September 2023. PATIENTS: All patients older than 16 years admitted to the ICU for severe DKA. INTERVENTION: The enrolled patient was assigned to receive RL or 0.9% SC according to the randomization scheme. Insulin therapy protocol was conducted similarly for all patients. MAIN VARIABLES OF INTEREST: Resolution of DKA at H48 defined by a composite endpoint (glycemia < 11 mmol/l, bicarbonates > 15 mmol/l or pH > 7.30 and anion gap < 16), change in base excess, insulin needs, fluid administration volume, electrolytes (sodium, potassium, chloride), ICU length of stay, and 28-day mortality. RESULTS: 88 patients were included: SC arm (n = 42) versus RL arm (n = 46). No significant differences were observed in diabetic ketoacidosis resolution, other variables of interest or in the subgroup analysis. The monitored biomarkers showed in the RL group: a better improvement of bicarbonate at H12 (p = 0.05), best potassium level both at H24 (p = 0.008) and H48 (0.041), lower chloride at H48 (p = 0.002) and higher glycemia at H24. CONCLUSION: RL did not lead to faster resolution of diabetic ketoacidosis but decreased the risk of hyperchloremia and hypokalemia without increasingthe chance of hyperlactatemia. CLINICAL TRIAL REGISTRATION NUMBER: NCT05808972.

INTRODUCTION: The optimal strategy for correcting metabolic acidosis and maintaining acid-base balance in hemodialysis patients remains unclear. This study aimed to evaluate and compare the effects of oral bicarbonate administration vs. increased dialysate bicarbonate concentration on predialysis serum bicarbonate levels in hemodialysis patients with metabolic acidosis. METHODS: This was a single-center, open-label, randomized controlled trial. Adult hemodialysis patients with metabolic acidosis (serum bicarbonate < 22 mmol/L) were randomly assigned in a 1:1:1 ratio to one of three treatment groups for 16 weeks: (1) standard dialysate (32 mM bicarbonate plus 3 mM acetate), (2) increased dialysate bicarbonate (34 mM bicarbonate plus 3 mM acetate), or (3) standard dialysate with daily oral sodium bicarbonate supplementation (0.3-0.5 mmol/kg). Of the 75 eligible participants, 66 completed the study. The primary outcome was the difference in predialysis serum bicarbonate levels between the groups at 16 weeks. RESULTS: Baseline predialysis serum bicarbonate levels averaged approximately 19.5 mmol/L across all three groups. At 16 weeks, there was no statistically significant difference in predialysis serum bicarbonate levels among the groups (p = 0.701). The mean levels were 20.1 (SD 2.16) mmol/L in the standard dialysate group, 20.5 (SD 2.04) mmol/L in the increased dialysate bicarbonate group, and 20.8 (SD 2.61) mmol/L in the oral supplementation group. Compared to baseline, predialysis bicarbonate levels significantly increased within the increased dialysate bicarbonate group (p = 0.010) and the oral supplementation group (p = 0.021), but not in the control (standard dialysate, no oral supplementation) group. CONCLUSION: Oral or dialytic bicarbonate supplementation at the doses used in this study demonstrated equivalent effects on predialysis serum bicarbonate concentrations in acidotic hemodialysis patients. However, the amount of supplemental bicarbonate administered via either route was insufficient to achieve the target correction of acidosis (e.g., predialysis serum bicarbonate ≥ 22 mmol/L). © 2025 International Society for Hemodialysis.

INTRODUCTION AND HYPOTHESIS: Achieving adequate pain relief is crucial for intradetrusor onabotulinumtoxinA treatments for idiopathic overactive bladder in office settings. The objective of this study was to determine whether buffered lidocaine bladder instillation provides better pain control than standard lidocaine prior to intradetrusor onabotulinumtoxinA injections. METHODS: We conducted a prospective, double-blind, randomized controlled trial comparing two protocols. The standard protocol used a pre-procedure instillation of 50 ml of 1% lidocaine and 50 ml of 0.9% saline. The buffered lidocaine protocol used 50 ml of 1% lidocaine, 45 ml of 0.9% saline, and 5 ml of 8.4% sodium bicarbonate. Both protocols were administered 20 min before onabotulinumtoxinA injections. Female patients with a primary diagnosis of idiopathic overactive bladder were randomized. The primary outcome was procedural pain using a visual analog scale (VAS) measured in millimeters, with secondary outcomes of patient satisfaction and willingness to repeat the procedure. RESULTS: Of the 76 patients enrolled, 38 were randomized to each group. Data were analyzed for 37 patients in the buffered lidocaine group, and 36 in the standard lidocaine group. Both groups had comparable baseline characteristics. There was no difference in median pain measured by VAS between the buffered (16 [9-40]) and standard (25 [15-55]) protocols (p = 0.21). The buffered group reported a higher, though not statistically significant, satisfaction rate (68% vs 39%, p = 0.08). CONCLUSION: Intradetrusor onabotulinumtoxinA injections are generally well tolerated among women with idiopathic overactive bladder. No difference was found between protocols, suggesting that buffered lidocaine instillation may not improve pain control among women with idiopathic overactive bladder, although we had insufficient power to detect a difference of the observed magnitude. © 2025. The International Urogynecological Association.

BACKGROUND: The ideal intravenous maintenance and resuscitation fluid for patients undergoing orthotopic liver transplantation (OLT) remains unknown. We aimed to determine whether bicarbonate-buffered solution was non-inferior to Plasma-LyteTM in preventing metabolic acidosis during OLT. METHODS: We conducted a pilot single-center, open-label, randomized trial to compare the physiological effects of intravascular volume maintenance with a bicarbonate-buffered solution vs. Plasma-LyteTM in adults undergoing OLT. Non-inferiority was defined as a median difference in the standard base excess (SBE) of less than -2.5 mEq/L. The primary endpoint was the SBE at 5 minutes post-reperfusion. Quantile regression analysis was applied to confirm non-inferiority. Secondary endpoints included other forms of acid-base and electrolyte imbalances at pre-specified time points and postoperative complications. RESULTS: We randomized 52 adults undergoing OLT. The median (Q1, Q3) volume infused was 5 000 (3 125, 7 000) ml in the bicarbonate-buffered solution group and 5 500 (4 000, 10 500) ml in the Plasma-LyteTM group (P = 0.37). The median (Q1, Q3) SBE at 5 minutes post-reperfusion was -4.857 (-6.231, -3.565) mEq/L in patients receiving bicarbonate-buffered solution and -4.749 (-7.574, -2.963) mEq/L amongst those in the Plasma-LyteTM group. The estimated median difference by quantile regression was -0.043 mEq/L (95% CI [-1.988 to 1.902] mEq/L; one-sided P = 0.015). There were no significant differences in the acid-base secondary outcomes, number of complications, or patient mortality. There were no reported adverse events or safety concerns associated with the use of either solution. CONCLUSIONS: A bicarbonate-buffered solution was non-inferior to Plasma-LyteTM for maintaining acid-base homeostasis post-reperfusion in OLT patients.

PURPOSE: To investigate the suitability of microdosed oral omeprazole for predicting CYP2C19 activity in vivo in combination with simultaneous assessment of CYP3A and CYP2D6 activity using both microdosed midazolam and yohimbine. METHODS: An open, fixed-sequence study was carried out in 20 healthy participants. Single microdosed (100 µg) and therapeutic (20 mg) doses of omeprazole were evaluated without comedication and after administration of established CYP2C19 perpetrators fluconazole (inhibition) and rifampicin (induction). To prevent degradation of the uncoated omeprazole microdose, sodium bicarbonate buffer was administered. The pharmacokinetics of omeprazole and its 5-hydroxy-metabolite were assessed as well as the pharmacokinetics of midazolam and yohimbine to estimate CYP3A4 and CYP2D6 activity. RESULTS: Calculated pharmacokinetic parameters after administration of 100 µg and 20 mg omeprazole in healthy subjects suggest dose proportionality. Omeprazole clearance was significantly decreased by fluconazole from 388 [95% CI: 266-565] to 47.2 [42.8-52.0] mL/min after 20 mg omeprazole and even further after 100 µg omeprazole (29.4 [24.5-35.1] mL/min). Rifampicin increased CYP2C19-mediated omeprazole metabolism. The omeprazole hydroxylation index was significantly related to omeprazole clearance for both doses. Both fluconazole and rifampicin altered CYP3A4 activity whereas no change of CYP2D6 activity was observed at all. CONCLUSIONS: Microdosed oral omeprazole is suitable to determine CYP2C19 activity, also during enzyme inhibition and induction. However, the administration of sodium bicarbonate buffer also had a small influence on all victim drugs used. TRIAL REGISTRATION: EudraCT: 2017-004270-34. © 2022. The Author(s).

Endovascular infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a major health care concern, especially infective endocarditis (IE). Standard antimicrobial susceptibility testing (AST) defines most MRSA strains as "resistant" to β-lactams, often leading to the use of costly and/or toxic treatment regimens. In this investigation, five prototype MRSA strains, representing the range of genotypes in current clinical circulation, were studied. We identified two distinct MRSA phenotypes upon AST using standard media, with or without sodium bicarbonate (NaHCO3) supplementation: one highly susceptible to the antistaphylococcal β-lactams oxacillin and cefazolin (NaHCO3 responsive) and one resistant to such agents (NaHCO3 nonresponsive). These phenotypes accurately predicted clearance profiles of MRSA from target tissues in experimental MRSA IE treated with each β-lactam. Mechanistically, NaHCO3 reduced the expression of two key genes involved in the MRSA phenotype, mecA and sarA, leading to decreased production of penicillin-binding protein 2a (that mediates methicillin resistance), in NaHCO3-responsive (but not in NaHCO3-nonresponsive) strains. Moreover, both cefazolin and oxacillin synergistically killed NaHCO3-responsive strains in the presence of the host defense antimicrobial peptide (LL-37) in NaHCO3-supplemented media. These findings suggest that AST of MRSA strains in NaHCO3-containing media may potentially identify infections caused by NaHCO3-responsive strains that are appropriate for β-lactam therapy.

The antibacterial properties of sodium bicarbonate have been known for years, yet the molecular understanding of its mechanism of action is still lacking. Utilizing chemical-chemical combinations, we first explored the effect of bicarbonate on the activity of conventional antibiotics to infer on the mechanism. Remarkably, the activity of 8 classes of antibiotics differed in the presence of this ubiquitous buffer. These interactions and a study of mechanism of action revealed that, at physiological concentrations, bicarbonate is a selective dissipater of the pH gradient of the proton motive force across the cytoplasmic membrane of both Gram-negative and Gram-positive bacteria. Further, while components that make up innate immunity have been extensively studied, a link to bicarbonate, the dominant buffer in the extracellular fluid, has never been made. Here, we also explored the effects of bicarbonate on components of innate immunity. Although the immune response and the buffering system have distinct functions in the body, we posit there is interplay between these, as the antimicrobial properties of several components of innate immunity were enhanced by a physiological concentration of bicarbonate. Our findings implicate bicarbonate as an overlooked potentiator of host immunity in the defense against pathogens. Overall, the unique mechanism of action of bicarbonate has far-reaching and predictable effects on the activity of innate immune components and antibiotics. We conclude that bicarbonate has remarkable power as an antibiotic adjuvant and suggest that there is great potential to exploit this activity in the discovery and development of new antibacterial drugs by leveraging testing paradigms that better reflect the physiological concentration of bicarbonate.

Dysregulation of uterine fluid environment could impair successful reproduction and this could be due to the effect of environmental estrogens. Therefore, in this study, effect of quercetin, an environmental estrogen on uterine fluid and electrolytes concentrations were investigated under sex-steroid influence. Ovariectomised adult female Sprague-Dawley rats were given 10, 50 or 100mg/kg/day quercetin subcutaneously with 17-β estradiol (E) for seven days or three days E, then three days E plus progesterone (P) (E+P) treatment. Uterine fluid secretion rate, Na+, Cl- and HCO3- concentrations were determined by in-vivo perfusion. Following sacrifice, uteri were harvested and levels of the proteins of interest were identified by Western blotting and Realtime PCR. Distribution of these proteins in the uterus was observed by immunofluorescence. Levels of uterine cAMP were measured by enzyme-linked immunoassay (EIA). Administration of quercetin at increasing doses increased uterine fluid secretion rate, Na+, Cl- and HCO3- concentrations, but to the levels lesser than that of E. In concordant, levels of CFTR, SLC4A4, ENaC (α, β and γ), Na+/K+-ATPase, GPα/β, AC and cAMP in the uterus increased following increased in the doses of quercetin. Co-administration of quercetin with E caused uterine fluid secretion rate, Na+, Cl- and HCO3- concentrations to decrease. In concordant, uterine CFTR, SLC26A6, SLC4A4, ENaC (α, β and γ), Na+/K+-ATPase, GPα/β, AC and cAMP decreased. Greatest effects were observed following co-administration of 10mg/kg/day quercetin with E. Co-administration of quercetin with E+P caused uterine fluid Na+ and HCO3- concentrations to increase but no changes in fluid secretion rate and Cl- concentration were observed. Co-administration of high dose quercetin (100 mg/kg/day) with E+P caused uterine CFTR, SLC26A6, AC, GPα/β and ENaC (α, β and γ) to increase. Quercetin-induced changes in the uterine fluid secretion rate and electrolytes concentrations could potentially affect the uterine reproductive functions under female sex-steroid influence.

We have investigated the effect of NaHCO3 on menadione redox cycling and cytotoxicity. A cell-free system utilized menadione and ascorbic acid to catalyze a redox cycle, and we utilized murine hepatoma (Hepa 1c1c7) cells for in vitro experiments. Experiments were performed using low (2 mmol/L) and physiological (25 mmol/L) levels of NaHCO3 in buffer equilibrated to physiological pH. Using oximetry, ascorbic acid oxidation, and ascorbyl radical detection, we found that menadione redox cycling was enhanced by NaHCO3. Furthermore, Hepa 1c1c7 cells treated with menadione demonstrated cytotoxicity that was significantly increased with physiological concentrations of NaHCO3 in the media, compared with low levels of NaHCO3. Interestingly, the inhibition of superoxide dismutase (SOD) with 2 different metal chelators was associated with a protective effect against menadione cytotoxicity. Using isolated protein, we found a significant increase in protein carbonyls with menadione-ascorbate-SOD with physiological NaHCO3 levels; low NaHCO3 or SOD-free reactions produced lower levels of protein carbonyls. In conclusion, these findings suggest that the hydrogen peroxide generated by menadione redox cycling together with NaHCO3-CO2 are potential substrates for SOD peroxidase activity that can lead to carbonate-radical-enhanced cytotoxicity. These findings demonstrate the importance of NaHCO3 in menadione redox cycling and cytotoxicity.

Fluorescein has been used for rapid and sensitive detection of fish skin and corneal ulceration. Effective use of the fluorescein test requires knowledge of conditions that might cause misleading interpretations or otherwise interfere with test reliability. Examination of fish health and the clinical workup often require tricaine as one of the most commonly used anesthetics. However, tricaine may interfere with correct interpretation of the fluorescein test and might also cause significant fish injury. The effects of tricaine exposure sequence on the fidelity of the fluorescein test was studied in Pacific halibut Hippoglossus stenolepis, walleye pollock Theragra chalcogramma, and northern rock soles Lepidopsetta polyxystra by examining the fluorescence of experimentally induced epidermal wounding. Tricaine can quench fluorescence that is emitted by fluorescein retained in skin ulcers, causing a false-negative reaction. Thus, for the fluorescein test to work properly, it is important to avoid the exposure of fluorescein-treated and rinsed ulcers to tricaine. The effects of exposure to buffered versus unbuffered tricaine on epidermal and corneal integrity were studied in Nile tilapia Oreochromis niloticus and channel catfish Ictalurus punctatus subjected to the fluorescein test and histological examination. Fluorescein could detect not only ulcers but also areas with only a partial loss of epithelium (i.e., erosion). The use of unbuffered tricaine to anesthetize these fish caused serious epidermal and corneal damage. If fish are euthanized with unbuffered tricaine for clinical workup, this severe epidermal or corneal damage could be misinterpreted as an antemortem lesion, leading to misdiagnosis. Even in water with alkalinity exceeding 50 mg/L as CaCO3, it would seem prudent to always buffer tricaine with sodium bicarbonate to prevent a pH change that might lead to iatrogenic effects from unbuffered tricaine. Thus, current general recommendations suggesting that tricaine does not need to be buffered in waters with alkalinity greater than 50 mg/L might need to be modified. Evaluation of antifungal activity of carbonate and bicarbonate salts alone or in combination

46. Commun Agric Appl Biol Sci. 2007;72(4):773-7. Evaluation of antifungal activity of carbonate and bicarbonate salts alone or in combination with biocontrol agents in control of citrus green mold. Zamani M(1), Sharifi Tehrani A, Ali Abadi AA. Author information: (1)Department of Plant Protecti

In this study, the influence of simultaneous application of anionic salts (AS) and rumen buffer (RB) on the metabolism of dairy cows was examined. Eleven rumen fistulated, non-pregnant and non-lactating dairy cows received equal amounts of one AS (CaCl2 or CaSO4) and one RB (NaHCO3 or KHCO3) via rumen cannula during feeding time over a period of eight days. Before the first application of AS and RB and on day eight of the treatment period, blood, urine and rumen fluid samples were taken. The following parameters were measured: whole blood: pH, base excess, bicarbonate; serum: sodium, potassium, chloride, calcium; urine: pH, net acid base excretion, sodium, potassium, chloride, calcium; rumen fluid: pH. The changes of each parameter were compared via ANOVA. The changes in acid-base balance on day eight were very small, although significant. But p-values showed that the statistical evidence was low. The most changes occurred when NaHCO3 was fed in combination with one of the AS used. In this case a small acidogenic load was seen in blood (p < 0.05), and calcium concentrations increased slightly (p < 0.05). No alkalotic reaction could be detected when any combination of AS and RB were given to the cows. Simultaneous application of AS and RB results in a loss of effectivity of AS. Neither an adequate acidification of blood nor an activation of calcium metabolism occurred. In feed ration for cows in the last weeks of pregnancy, rumen buffer must not be fed, if anionic salts are given for prevention of parturient paresis.

We describe a model to illustrate different chemical interactions that can occur in urine following ingestion of individual and combined health supplements. Two types of interactions are defined: synergism and addition. The model was applied to eight healthy males who participated in a study to investigate the chemical interactions between calcium carbonate, magnesium oxide and sodium citrate-bicarbonate health supplements on calcium oxalate urinary stone risk factors. Subjects ingested these components individually and in combination for 7 days. Twenty-four-hour urines were collected at baseline and during the final day of supplementation. These were analysed using standard laboratory techniques. Three different chemical interactions, all involving citrate, were identified: magnesium and citrate exerted a synergistic effect on lowering the relative superaturation (RS) of brushite; the same two components produced a synergistic effect on raising pH; finally, calcium and citrate exerted an additive effect on lowering the RS of uric acid. We propose that the novel approach described in this paper allows for the evaluation of individual, additive and synergistic interactions in the assessment of the efficacy of stone-risk reducing preparations.

We tested the hypothesis that nitric oxide has a positive inotropic effect on mammalian cardiac muscle contractility and that this effect sums with the positive inotropic effect of beta1-adrenergic agonists when both are present. Feline right ventricular papillary muscles were stimulated to contract isometrically at 0.2 Hz in Krebs-Henseleit bicarbonate buffer (KREBS) gassed with 95% O2 and 5% CO2 (26 degrees C; pH 7.34). The nitric oxide (NO) donor, S-nitroso-N-acetylpenicillamine (SNAP, 10(-5) M), and the membrane permeable cGMP analog 8-bromoguanosine-3',5'-cyclophosphate sodium (Br-cGMP, 10(-5) M), significantly increased developed force by 13.3+/-1.5% (n = 11) and 7.8+/-2.8% (n = 7), respectively. SNAP, at 10(-5) M, significantly increased the force developed by papillary muscle treated with 10(-11) M or 10(-9) M dobutamine hydrochloride (a beta1-adrenergic agonist) (n = 25, 11.3+/-2.9% and 10.0+/-3.6%, respectively) when compared with the addition of KREBS (n = 27, 2.6+/-0.9% and 5.5+/-0.9%), but the increase was less than predicted by the sum of inotropic effects of SNAP and dobutamine. SNAP at 10(-5) M did not change developed force in muscles treated with 10(-7) M dobutamine but it significantly decreased developed force in muscles challenged with 10(-5) M dobutamine (n = 18, 29.3+/-5.0%) when compared with KREBS (n = 10, 41.5+/-6.8%). Similarly, 10(-4) M 8-bromo-adenosine cyclic 3',5'-hydrogen phosphate monosodium (a membrane permeable cAMP analog) increased developed force 14.9+/-3.3% and the addition of 10(-5) M Br-cGMP to those muscles significantly reduced developed force by 3.5%+/-1.1% (n = 7). Thus, the positive inotropic effect of NO decreased and ultimately became an attenuation as the level of beta1-adrenergic stimulation increased due at least in part, to an interaction between the cAMP and cGMP second messenger pathways.

Proton pump inhibitors (PPIs) differ in onset of action and bioavailability. This trial was conducted to investigate the pharmacokinetics and pharmacodynamics of an immediate-release capsule formulation containing lansoprazole 30 mg and sodium bicarbonate 1100 mg (T preparation) in healthy Chinese subjects. This was an open, single-center, randomized, single and multiple oral doses, and two-period crossover study in 30 healthy subjects. After single- and multiple-dose oral administration, blood samples were obtained and lansoprazole concentration in serum was measured for pharmacokinetic analysis. Meanwhile, the intragastric pH was monitored continuously to evaluate the pharmacodynamics of the investigational drugs. The Tmax of the T preparation was 0.5 hours, while the Tmax of the R preparation was 1.5 hours after multiple doses, which indicated that the absorption speed of the T preparation was significantly faster than that of the R preparation. The same characteristics also existed after single-dose administration. The area under the curve (AUC)ss of the T preparation was bio-equivalent to that of the R preparation under steady state. The time percentage of intragastric pH > 4.0 for the T preparation was higher than that of the R preparation after 1 hour for both single- and multiple-dose. It suggested compared with R preparation, the time percentage of intragastric pH > 4.0 met the criteria for superiority after 1 hour administration for the T preparation. In addition, no serious adverse events occurred in this study. Across this study, the T preparation was better than the R preparation at improving drug absorption and increasing intragastric pH, and had a favorable safety profile. © 2023, The American College of Clinical Pharmacology.

Comment in J Gastroenterol Hepatol. 2010 Jan;25(1):6-7. doi: 10.1111/j.1440-1746.2009.06166.x. BACKGROUND AND AIMS: A pH of more than 6 is required for clot stability and hemostasis. Intravenous proton pump inhibitors have a rapid onset of action compared to oral and have been preferred for management of non-variceal bleeding. Intravenous pantoprazole has been used extensively. Buffered esomeprazole (BE) is an oral preparation consisting of an inner core of non-enteric-coated esomeprazole with a shell of sodium bicarbonate. The buffer protects against acid degradation of esomeprazole in addition to immediate antacid action. The aim of this study was to assess the efficacy of BE for raising and maintaining an intragastric pH of more than 6 in comparison to i.v. pantoprazole in equivalent dosing. METHODS: A randomized two-way cross-over study was conducted. Ten healthy volunteers were randomized to twice daily BE 40 mg or pantoprazole 40 mg i.v. bolus. Intragastric pH was measured with a wireless pH radiotelemetry capsule (Bravo, Medtronic). A 2-week washout period was given between doses. RESULTS: BE achieved a steady pH of more than 6 in a median time of 2 min (range 1-5 min) after the first dose. The mean % time that intragastric pH was more than 6.0 for BE was 96%, and 90% of the 24-h period compared to pantoprazole (47% and 18%), P = 0.000. A median pH (interquartile range) for the BE group was 6.2 (6.175-6.2) which was higher than i.v. pantoprazole 4.60 (4.5-5.0) (P = 0.005). CONCLUSION: BE achieves and maintains a pH of more than 6 within minutes of administration. It was significantly superior to i.v. pantoprazole in equivalent dosing. This finding could have implications in the management of non-variceal bleed where a rapid and sustained pH of more than 6 is desirable.