most places here have to get it from pharmacy or gets mixed in ED (particularly if you have ED pharmacists

Super interesting topic. I’ve done this and teach it but will have to reconsider

I use the standing algorithm

Thanks for sharing. Definitely interesting but I question if it would be the same in critically ill non-ventilated patients presenting with metabolic acidosis
Regardless, agree that infusion is the bigger chance for a win

Agree with you but, BICARICU2 was infusion not push dose which I think matters
also, dialysis is a bit of a clinician driven thing and this wasn't blinded
regardless, the minimal cost of some bicarb compared to dialysis is a win

Can I suggest getting a cup of coffee instead?

only if you really really really really want to

thanks for sharing. I've got to review in full but issues I see: how was bicarb given (this seems like infusion, not push dose), obviously not an RCT (lots of confounding) and they excluded things like DKA which is odd

As an TCCC instructor I would add "reassess constantly, consider conversion or removal if not needed, and be prepared to manage Reperfusion injury"