Metabolic acidosis is the most common acid-base abnormality encountered. It is present when there is a decrease in plasma Bicarbonate– concentration, leading to a decrease in plasma pH. Recognizing and correcting metabolic acidosis is important, owing to the pathophysiological changes a decreased plasma pH can cause. Effects of acidosis include suppression of cardiac contractility, arteriolar vasodilatation, increased pulmonary vascular resistance, and increased susceptibility to ventricular arrhythmias. Administration of sodium bicarbonate enhances elimination through the mechanism of ion trapping: Alkalinization of blood and urine increases the proportion of the ionized form of the drug, causing more unionized drug to leave cells and enter the blood or urine where it is converted to the poorly diffusible ionized form. Potential complications of sodium bicarbonate therapy include hypernatremia, hypokalemia, hypocalcemia, the development of iatrogenic alkalosis, volume overload secondary to the large amount of sodium that may be administered, and paradoxical cerebrospinal fluid acidosis.