Bicarbonate therapy

Follow-up with arterial blood gases to determine correction and need for additional sodium bicarbonate therapy... 

Metabolic acidosis In severe renal disease uncontrolled diabetes circulatory insufficiency due to shock, anoxia, or severe dehydration extracorporeal circulation of blood cardiac arrest and severe primary lactic acidosis where a rapid increase in plasma total CO2 content is crucial. Treat metabolic acidosis in addition to measures designed to control the cause of the acidosis. Because an appreciable time interval may elapse before all ancillary effects occur, bicarbonate therapy is indicated to minimize risks inherent to acidosis itself. 

Bicarbonate Current guidelines state that acidosis need not be corrected using exogenous bicarbonate therapy. Intravenous administration of fluids and insulin are sufficient to correct the metabolic acidosis and to regenerate bicarbonate. Some practitioners believe, however, that bicarbonate repletion should be provided in the setting of severe acidosis with pH less than 6.9. 

Morris LR, Murphy MB, Kitabchi AE Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med 105 836-840,1986. 

Hoffman JR, McElroy CR. Bicarbonate therapy for dysrhythmia hypotension in tricyclic antidepressant overdose. West J Med 1981 134(l) 60-4. 

Chisholm, C.D., Singletary, E.M., Okerberg, C.V. (1989). Inhaled sodium bicarbonate therapy for chlorine inhalation injuries (Abstract). Ann. Emerg. Med. 18 466. 

Reif S, Holzman M, Barak S, Spirer Z. Absence seizures associated with bicarbonate therapy and normal serum pH. JAMA 1989 262(10) 1328-9. 

Graf H, Leach W, Arieff A11985 Evidence for a detrimental effect of bicarbonate therapy in hypoxic lactic acidosis. Science 227 754-756... 

In most cases of acute respiratory acidosis, such as following cardiopulmonary arrest, sodium bicarbonate therapy is not indicated and may be detrimental. Blood gas analysis should guide therapy. 

Excessive bicarbonate therapy of an organic acidosis Mild/moderate potassium deficiency Sodium chloride-resistant (urinary chloride concentration >20 mEq/L)... 

Sing RF, Branas CA, Sing RF. Bicarbonate therapy in the treatment of lactic acidosis Medicine or toxin J Am Ostepath Assoc 1995 95 52-57. 

B. Specific drugs and antidotes. Treat cardiotoxic effects such as wide QRS intervals or hypotension with sodium bicarbonate (see p 419), 1-2 mEq/kg rapid IV bolus, repeated every 5-10 minutes and as needed. Markedly impaired conduction or high-degree atrioventricular (AV) block unresponsive to bicarbonate therapy is an indication for insertion of a cardiac pacemaker. 

The administration of bicarbonate is to be used with cautioa The indiscriminate use of bicarbonate is particularly dangerous in resuscitation of patients with metabolic acidosis as a concomitant of hypovolaemic shock lactic acid itself is innocuous and is readily removed by the liver as soon as the perfusion of the tissues is re-established. If administration of bicarbonate causes alkalosis and shifts the oxygen dissociation curve to the left, there is interference with oxygen unloading at the cellular level in tissues which are already hypoxic. Treatment of metabolic acidosis by bicarbonate therapy is reserved for situations in which partial correction of the pH is needed to restore cardiac function, which is depressed by acidaemia as described in Chapter 4. 

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