S01E14 BICARICU-2: Bicarbonate for Severe Acidemia + AKI

In this episode, we break down BICARICU-2, a multicenter open-label randomized clinical trial of 4.2% IV sodium bicarbonate in critically ill adults with severe metabolic acidemia (pH ≤7.20) and moderate-to-severe AKI (KDIGO 2–3). We cover the physiology (why acidemia matters), the trial design (and what open label means for dialysis decisions), and the outcomes that should change bedside behavior. Bottom line: bicarbonate did not improve 90-day all-cause mortality (62.1% vs 61.7%), but it was associated with less kidney replacement therapy by day 28 (35% vs 50%). We close with a practical, conditional approach to when bicarbonate is reasonable as a temporizing strategy—and when it shouldn’t delay needed KRT. Educational use only; not medical advice.JAMA (2025) — “Sodium Bicarbonate for Severe Metabolic Acidemia and Acute Kidney Injury: The BICARICU-2 Randomized Clinical Trial” https://jamanetwork.com/journals/jama/fullarticle/2840824PubMed (2025) — BICARICU-2 trial recordhttps://pubmed.ncbi.nlm.nih.gov/41159812/JAMA (2025) Editorial — “Sodium Bicarbonate in Severe Acidemia and Acute Kidney Injury—Turning the Tide or Chasing a Myth?”https://jamanetwork.com/journals/jama/fullarticle/2840826Tags#CriticalCare #ICU #Nephrology #AcuteKidneyInjury #AKI #MetabolicAcidosis #SevereAcidemia #SodiumBicarbonate #RenalReplacementTherapy #Dialysis #Sepsis #Shock #RandomizedClinicalTrial #EvidenceBasedMedicine #JournalClub #JAMA#IntensiveCare #CriticalCareMedicine #PulmCrit #FOAMed #MedEd #ResidentEducation #FellowEducation #ICUPharmacology #AcidBase #AcidBasePhysiology #Electrolytes #Hemodynamics #SepticShock #Vasopressors #KidneySupport #CRRT #RenalFailure #AKIRecovery #ClinicalTrials #RCT #JAMAPaper #JournalReview #CriticalAppraisal