Sodium lactate 9.25g/500ml infusion bags

BackgroundSodium bicarbonate (NaHCO3) ingestion can induce extracellular alkalosis, but its effects on high-intensity intermittent exercise (HIIE) performance in team sports remain unclear. This study evaluated the effects of acute or short-term NaHCO3 ingestion on HIIE performance and physiological responses in team-sport athletes.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Six databases were searched from inception for randomized controlled trials, with the final search conducted on July 26, 2026. HIIE performance outcomes were synthesized using a covariance-adjusted three-level random-effects meta-analysis, whereas blood lactate, bicarbonate ( HCO3- ), and pH were analyzed separately using two-level random-effects models. Subgroup, meta-regression, and sensitivity analyses were conducted. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.ResultsTwenty studies involving 241 athletes contributed 53 performance effect sizes. NaHCO3 ingestion had a small beneficial effect on HIIE performance (Hedges' g = 0.23, 95% CI: 0.07 to 0.39, P = 0.008; 95% PI: -0.22 to 0.68; I2 = 37.36%). No clear effects were identified for repeated-sprint performance, mean power, intermittent endurance, or work capacity, and neither subgroup analyses nor meta-regression identified significant moderating effects of sex, dose, ingestion frequency, formulation, exercise phase, or rest/work ratio. NaHCO3 ingestion increased post-exercise blood lactate (MD = 1.73 mmol/L, 95% CI: 0.97 to 2.49), HCO3- (MD = 2.73 mmol/L, 95% CI: 2.16 to 3.30), and pH (MD = 0.050, 95% CI: 0.025 to 0.075). The performance findings remained stable across alternative correlation assumptions, one-primary-outcome-per-study analyses, and leave-one-study-out analyses. Certainty of evidence was low for HIIE performance and HCO3- and very low for blood lactate and pH.ConclusionAcute or short-term NaHCO3 ingestion may provide a small average improvement in HIIE performance and increase post-exercise blood lactate, HCO3- , and pH. However, the prediction interval crossed zero, and no consistent moderators were identified. Its practical use should therefore be individualized according to the exercise task, performance response, and gastrointestinal tolerance.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261424869, identifier: CRD420261424869.

Abstract licence: CC BY

BackgroundTwo randomized trials (BICAR-ICU and BICAR-ICU2) evaluated intravenous sodium bicarbonate therapy in patients with severe metabolic acidemia but yielded inconclusive results. We performed an individual patient data meta-analysis to assess its effects on 90-day mortality and renal replacement therapy (RRT) use, and search for heterogeneity of treatment effects across prespecified subgroups.MethodsWe performed an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials, including adults with severe metabolic acidemia (pH ≤ 7.20). Patients were randomized to receive intravenous sodium bicarbonate titrated to a pH ≥ 7.30 or no sodium bicarbonate. The primary outcome was 90-day mortality. Secondary outcomes included RRT initiation and dialysis-free days. Prespecified subgroup analyses explored treatment-effect heterogeneity by acidemia depth (pH ≤ 7.10 vs. > 7.10), severe acute kidney injury (AKI) status, and serum lactate (ResultsA total of 1,016 patients was included (509 sodium bicarbonate, 507 control). Sodium bicarbonate therapy did not significantly reduce 90-day mortality compared to control (58.3% vs. 60.6%; risk ratio [RR], 0.96; 95%CI, 0.86-1.07; p = 0.51). However, it significantly reduced RRT initiation (34.8% vs. 50.7%; RR, 0.69; 95%CI, 0.60-0.79; p  7.10 (RR, 1.05; 95%CI, 0.92-1.21; p = 0.47). No significant interactions were observed for severe AKI status (p-for-interaction = 0.11) nor serum lactate (p-for-interaction = 0.22).ConclusionsSodium bicarbonate therapy did not reduce overall 90-day mortality but decreased RRT use and suggested a mortality benefit in patients with the most profound acidemia (pH ≤ 7.10). These findings invite a reconsideration of current paradigms, suggesting timely correction of severe metabolic acidemia to avoid RRT in some patients.

Abstract licence: CC BY-NC-ND