Cardiac arrest sodium bicarbonate

This electrolyte plays a vital role in the acid-base balance of the body. Bicarbonate may be given IV as sodium bicarbonate (NaHC03) in the treatment of metabolic acidosis, a state of imbalance that may be seen in diseases or situations such as severe shock, diabetic acidosis, severe diarrhea, extracorporeal circulation of blood, severe renal disease, and cardiac arrest. Oral sodium bicarbonate is used as a gastric and urinary alkalinizer. It may be used as a single drug or may be found as one of the ingredients in some antacid preparations. It is also useful in treating severe diarrhea accompanied by bicarbonate loss. 

Sodium bicarbonate administration for cardiac arrest is controversial because there are few clinical data supporting its use, and it may have some detrimental effects. Sodium bicarbonate can be used in special circumstances (i.e., underlying metabolic acidosis, hyperkalemia, salicylate overdose, or tricyclic antidepressant overdose). The dosage should be guided by laboratory analysis if possible. 

A 25-year-old man had a cardiac arrest after taking one knot or sealed bag of crack cocaine (2.5 g) and was resuscitated. His arterial blood pH was 6.92 and an electrocardiogram showed sinus rhythm, QRS axis 300°, and terminal 40 msec of the QRS axis 285°. After an infusion of sodium bicarbonate, his blood pH was 7.30, his QRS axis 15°, and the terminal 40 msec QRS axis 30°. He passed the bag of cocaine rectally within 12 hours of admission. 

An overdose of acebutolol (6.4 mg) in a 48-year-old man caused cardiac arrest with ventricular tachycardia (5). An intravenous bolus of sodium bicarbonate 50 mmol produced sinus rhjThm. 

Vaupshas H J, Levy M 1990 Distribution of saline following acute volume loading postural effects. Clinical and Investigative Medicine 13 165-177 Velanovich V 1989 Crystalloid versus colloid fluid resuscitation a meta-analysis of mortality. Surgery 105 65-71 Vukmir R B, Bircher N G, Radovsky A et al 1995 Sodium bicarbonate may improve outcome in dogs with brief or prolonged cardiac arrest. Critical Care Medicine 23 515-522 Walton R J 1979 Effect of intravenous sodium lactate on renal tubular reabsorption of phosphate in man. Clinical Science 57 125-127... 

Although sodium bicarbonate was once given routinely to reduce the detrimental effects associated with acidosis (e.g., reduced myocardial contractflity), enhance the effect of epinephrine, and improve the rate of deflbrillation, its use for cardiac arrest has been extremely controversial over the past several years. Unfortunately, there are few clinical data supporting sodium bicarbonate use. Furthermore, sodium bicarbonate may have some detrimental effects. " The effect of sodium bicarbonate can be described by the following reaction ... 

Acute barbiturate toxicity is characterized by automatism, or a state of drug-induced confusion, in which patients lose track of how much medication they have taken and take more. Death results from respiratory failure. The treatment of poisoning consists of supporting respiration, prevention of hypotension, as well as diuresis, hemodialysis and, in the event of phenobarbital poisoning, the administration of sodium bicarbonate. Tolerance does not develop from lethal doses. The abrupt withdrawal from barbiturates may cause tremors, restlessness, anxiety, weakness, nausea and vomiting, seizures, delirium, and cardiac arrest. 

A 17-year-old boy took propafenone 3 g and had a sudden cardiac arrest with h5fpotension, left ventricular failure, bradycardia, sinoatrial block, and an atrioventricular junctional and ventricular tachycardia. He was treated with temporary cardiac pacing, catecholamines, and sodium bicarbonate, and the toxicity resolved within 4 hours [66 ]. 

A 56-year-old man presented in cardiac arrest and asystole after ingesting 7 g of lacosamide in a suicide attempt. After resuscitation, the patient had a jxmctional rhythm with widened QRS and hemi-left anterior bxmdle and complete right bundle branch block [73 ]. This patient ultimately died. It is important to be aware that lacosamide toxicity may cause widened QRS and can lead to death. Treatment should include sodium bicarbonate. 

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