Crystalloids sodium bicarbonate

Ringer s lactate, in which lactate is added to Ringer s solution, is probably the most popular crystalloid (salt) solution for intravenous use in humans. The lactate is gradually converted to sodium bicarbonate within the body so that an uncompensated alkalosis is prevented (13). These crystalloid solutions cannot support life without red cells saline passes rather quickly into the tissue spaces of various organs (14), especially the Hver (15). 

Lactic acidosis should be treated with large volumes of polyionic crystalloid solutions. As discussed above, the use of sodium bicarbonate in lactic acidosis is highly controversial and not recommended (Forsythe Schmidt 2000). 

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... 

Patients suffering from mild or moderate exposures may only require supportive care and observation (8,21). More severe exposures necessitate basic life support, including mechanical ventilation, 100% oxygen, circulatory support with crystalloid and vasopressor agents, sodium bicarbonate for correction of the metabolic acidosis and seizure control with benzodiazepines (7,21). 

The calculated loading dose of alkali should be administered over several days to avoid volume overload from the accompanying sodium load. For this scenario, a regimen of 60 to 70 mEq three times a day for 3 to 5 days should result in an increase in HCOj levels toward normal. In addition to the calculated loading dose, supplemental alkali must also be provided to replace ongoing losses, which can be approximated to be 2 mEq/kg per day or 40 mEq three times a day. In patients with associated volume depletion, bicarbonate replacement can be provided simultaneous with volume resuscitation by substituting bicarbonate for chloride in intravenous crystalloid solutions. 

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