Sodium bicarbonate did not protect the kidneys in metabolic acidosis with shock

The edition in brief

SODa-BIC randomised 500 adults with metabolic acidosis on vasopressors in 55 ICUs to sodium bicarbonate or placebo for up to five hours; major adverse kidney events at 30 days were 40.2% vs 39.4% (adjusted difference 1.2 points, 95% CI −7.1 to 9.4), with no significant difference in dialysis or mortality. Among 2,085 adolescents with a positive Ask Suicide-Screening Questions result in US emergency departments, 11.6% attempted suicide within three months; a suicide attempt in the past month, prior non-suicidal self-injury, prior psychiatric admission and hopelessness were associated with higher risk. A double-blind trial in 120 ventilated adults found low-dose ketamine at 0.15 mg/kg/h lowered opioid requirements (median 64 vs 77 µg/h fentanyl equivalents; 95.1% probability of benefit) without more delirium. The FDA recorded a supplement to Gland's generic adrenaline application; this is an administrative action, not a new indication or safety finding.