Buffers in intravenous solutions: is the source of bicarbonate a source of confusion?

There is a widespread belief that organic sodium salts included in intravenous solutions serve as bicarbonate precursors, and that this mechanism explains their effects on plasma pH. We aimed to explain why the effect of organic anions, such as citrate, acetate, gluconate, and lactate on the acid-base balance is independent of bicarbonate generation. For this purpose, we mainly focused on regional citrate anticoagulation (RCA). The sodium load provided with these buffers and its contribution to the plasma strong ion difference is a more suitable model for explaining and predicting their alkalinizing effect. Moreover, the bicarbonate generated from the metabolization of these buffers via the Krebs cycle results from CO<sub>2</sub> dissolution in water, and thus yields bicarbonate together with a proton (H<sup>+</sup>). As such, metabolization of these buffers does not cause alkalosis per se.

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Publication Details

Journal
Critical Care
Published
2025-11-26
DOI
https://doi.org/10.1186/s13054-025-05780-2
Citations
2
Primary Topic
Renal function and acid-base balance
Type
article
Field-Weighted Citation Impact
2.86
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article

Buffers in intravenous solutions: is the source of bicarbonate a source of confusion?

Eduardo Smelin Perdomo Domínguez, John A. Kellum, Daniel Iglesias‐Serret, Xosé Pérez-Fernández et al.
2 citations
Critical Care
Renal function and acid-base balance
2.86
article

Buffers in intravenous solutions: is the source of bicarbonate a source of confusion?

Eduardo Smelin Perdomo Domínguez, John A. Kellum, Daniel Iglesias‐Serret, Xosé Pérez-Fernández, Raül Rigo‐Bonnin, Juan V. Lorente-Olazábal, Joan Sabater‐Riera, Josep J. Centelles, Antoni Betbesé, Ana Campos-Gómez, A.G. Ulsamer
article en
2 citations

Abstract

There is a widespread belief that organic sodium salts included in intravenous solutions serve as bicarbonate precursors, and that this mechanism explains their effects on plasma pH. We aimed to explain why the effect of organic anions, such as citrate, acetate, gluconate, and lactate on the acid-base balance is independent of bicarbonate generation. For this purpose, we mainly focused on regional citrate anticoagulation (RCA). The sodium load provided with these buffers and its contribution to the plasma strong ion difference is a more suitable model for explaining and predicting their alkalinizing effect. Moreover, the bicarbonate generated from the metabolization of these buffers via the Krebs cycle results from CO<sub>2</sub> dissolution in water, and thus yields bicarbonate together with a proton (H<sup>+</sup>). As such, metabolization of these buffers does not cause alkalosis per se.

Critical CareVol. 29(1)
University of Pittsburgh (US), Hospital de Sant Pau (ES), Bellvitge University Hospital (ES), Institut d'Investigació Biomédica de Bellvitge (ES), Institute for Research in Biomedicine (ES), Hospital Juan Ramón Jiménez (ES), Hospital Universitario HM Sanchinarro (ES), Hospital Universitari Germans Trias i Pujol (ES), Universitat de Barcelona (ES)
Openalex Percentile: Top 8%
Renal function and acid-base balance
2.86
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