174 Administration of Sodium Bicarbonate

Question 1

When is the use of sodium bicarbonate recommended in DKA?

Answer 1

Limit use to patients with pHa <7.0 or 7.1 despite IV fluids and insulin.

(According to the medical literature, treatment of DKA with SB has not been successful and has been associated with hypokalemia, intracellular acidosis, and worsened tissue hypoxia. Clinical prospective studies are lacking, but general recommendation for SB in DKA animals is to limit use to patients with pHa <7.0 or 7.1 despite IV fluids and insulin.)

Question 2

Use of SB for treatment of lactic acidosis ?

Answer 2

Currently, SB is not recommended for LA regardless of pHa.

Question 3

Use of SB for treatment of hyperkaliemia?

Answer 3

Avoid SB use for treatment of hyperkalemia unless the patient is also severely acidotic

Question 4

Use of SB in cardiopulmonary cerebral resuscitation ?

Answer 4

American Heart Association (AHA) guidelines: no SB in cardiopulmonary cerebral resuscitation (CPCR) except under special circumstances (cocaine and antiarrhythmic (Ia and Ic) overdose and hyperkalemia)
RECOVER guidelines: SB is not recommended routinely but can be considered in prolonged CPCR >10–15 minutes without rapid return of spontaneous circulation (ROSC)