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To the Editor: Dr Brar and colleagues¹ studied the use of sodium bicarbonate to prevent CIN. If effective, sodium bicarbonate would be a readily available, inexpensive, and safe means to prevent a common iatrogenic cause of renal damage. In interpreting this study, several aspects of the design introduced differences between the intervention and control groups beyond the type of fluid administered.

By choosing to mix sodium bicarbonate into a dextrose solution (instead of into sterile water), the researchers created a hyperosmolar fluid. The dextrose and bicarbonate solution given to the intervention group had 478 mOsm/L while the normal saline given to the control group had a physiologic osmolarity of 310 mOsm/L. The hyperosmolar nature of the fluid given to the bicarbonate group could have potentially obscured any benefit of bicarbonate on glomerular flow rate.²

Additionally, the sodium concentrations of the fluid administered to the 2 groups were different: 130 mEq . . . [Full Text of this Article]

Bradley D. Shy, MD
bradley.shy@nyumc.org
Department of Emergency Medicine

Amit Gupta, MD; Robert S. Hoffman, MD
New York City Poison Control Center
New York University School of Medicine
New York, New York

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