A Cochrane review on the efficacy of alkalinisation for the treatment of acute organophosphorus pesticides (OP) poisoning included 2 studies with a total of 158 subjects. In the higher dose study, (NaHCO3 5 mEq/kg intravenously over one hour, followed by an infusion of 5–6 mEq/kg over 23 hours. The infusion was repeated every day until recovery/death) the RR of death in patients receiving NaHCO3 compared to controls was 0.52 (95% CI 0.05 to 5.39) and the WMD for total dose of atropine was -36.1 (95% CI –68.43 to –3.77). No clinical benefits from lower dose NaHCO3 were noted.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment), by inconsistency (heterogeneity in interventions), and by imprecise results (few patients and wide confidence intervals).