The edition · Emergency & Critical Care
Bicarbonate for acidosis on vasopressors did not lower kidney events; IV ketamine sedation in children looks safe in a large review
A double-blind ICU trial of sodium bicarbonate, an FDA supplement for a generic epinephrine product, risk factors for a suicide attempt after a positive teen screen, and pooled safety data on paediatric ketamine sedation.
The edition in brief
In SODa-BIC, published in June, 500 adults in 55 ICUs with metabolic acidosis (pH below 7.30) receiving vasopressors were randomised to sodium bicarbonate or placebo. A major adverse kidney event within 30 days occurred in 40.2% with bicarbonate and 39.4% with placebo (adjusted difference 1.2 percentage points, 95% CI -7.1 to 9.4); 30-day in-hospital mortality was 25.4% vs 24.0%, and adverse effects numbered four versus none. The FDA recorded a supplement dated 22 September 2026 to a generic epinephrine application; the entry does not say what changed. A secondary analysis of a prospective cohort of 2,085 adolescents aged 12 to 17 with a positive Ask Suicide-Screening Questions result found 11.6% attempted suicide within three months; a past-month attempt (aOR 2.52), past non-suicidal self-injury (2.06), prior mental health hospitalisation (1.39) and hopelessness (1.30) were associated with an attempt. A systematic review of 20 studies (58,752 children) of intravenous ketamine for procedural sedation reported no deaths, a pooled sentinel event rate of 1 per 24,390 sedations and serious adverse events in 0.33%; age 10 or over, upper respiratory infection and co-administered opioids were modest predictors. The pearl covers intramuscular epinephrine for anaphylaxis.
Sodium bicarbonate in metabolic acidosis on vasopressors did not reduce major kidney events
Sodium bicarbonate did not reduce 30-day major adverse kidney events in acidotic patients on vasopressors, so avoid routine use to treat the number.
FDA records a supplement to a generic epinephrine application
No action is needed from this entry alone; check the current product information if you use this generic.
In teens with a positive suicide screen, recent attempts and hopelessness marked higher risk of a later attempt
In teenagers with a positive suicide screen, use recent attempt, self-injury, past admission and hopelessness to inform the risk assessment and the follow-up plan.
In anaphylaxis, give intramuscular epinephrine first
Give intramuscular epinephrine at once for suspected anaphylaxis, and repeat it if the patient does not improve.
Intravenous ketamine for children's procedural sedation: serious events were rare in 58,752 children
Consider intravenous ketamine for paediatric procedural sedation with appropriate monitoring, taking extra care with older children, upper respiratory infection and co-administered opioids.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for emergency & critical care, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free