Does the buffer make a difference?

  • There is no conclusive evidence of a benefit on survival or renal outcome with either bicarbonate or renal outcomes
  • Both types have advantages and disadvantages:

Bicarbonate Buffer

Lactate Buffer

  • May result in better control of acidaemia
  • May result in improved cardiovascular stability
  • Unstable in solution, need to be prepared just prior to use
  • More expensive
  • Cheaper than bicarbonate buffer
  • Longer shelf life
  • Can result in rise in serum lactate:
    • Lactate intolerance defined by rise in lactate >5 mmol/L
    • Should be switched to bicarbonate buffer