Recently finished a cardiac rotation. I worked with more than a few CRNAs who felt the need to treat any metabolic acidosis whatsoever with bicarb. Im talking a pH of 7.32 or even higher if they noticed a downward trend in the HCO3. My understanding is that this accomplishes exactly nothing except correction of the number and can potentially be harmful. IMO the goal should be to correct the underlying problem which in our case is usually hypoperfusion and lactic acidosis. Wouldn't mild acidosis be beneficial in hypoperfusing states d/t the rightward shift in O2-Hb curve and easier O2 unloading? In addition to that you cant use BD, HCO3-, and lactate to follow trends anymore since you falsely "corrected" them right? I have seen recommendations not to use NaHCO3 unless ph is less than 7.2. I could see myself treating earlier than that depending on the situation but still. Am I missing something?