The article summarizes therapeutic approaches to treatment of metabolic acidosis with special emphasis on administration of sodium bicarbonate. Indications for use of NaHCO3 in acidotic states of different etiology have been widely discussed during the last decade. Metaanalyses of controlled clinical studies on bicarbonate in metabolic acidosis suggest that sodium bicarbonate may not have a positive effect on the outcome in patients with metabolic acidosis and the published data contributed to re-evaluation of traditional indications of buffer solutions, i.e. acidosis associated with shock, diabetic ketoacidosis. Recent indications for use of bicarbonate have been divided into four classes, from definitely helpful to potentially harmful.

        Key words: bicarbonate, NaHCO3, acidosis, alkalination, buffer, lactate.