Bicarbonate

Specialties CCU

Published

Hi! Can anyone help me understand why not to give bicarbonate to a patient when they are receiving potassium or insulin? I think it has to do with the shifting of electrolytes, but I don't thoroughly understand!

Thanks for your help!

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Do some reading regarding acid and base balance. Specifically regarding Hydrogen and potassium. I think you will find an answer then.

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Specializes in Critical Care (ICU and ER).

it has to do with the transport of hydrogen vs transport of potassium across the cell membrane. i'm not 100% sure but i think for every .1 change in ph there is a .6 change in k. and it's inversely proportionate.

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Specializes in ER, ICU.

hydrogen and potassium are both positively charged ions. There is an electrical gradiant just like others like hydrostatic and so on. Bicarb sucks up the H ions which is why its given for acidosis. As the H ions are bound by the bicarb this changes the electrical gradient to more negative in the blood, which draws the K ions out of the cells to acheive electrical homeostasis. This raises serum K, which can lead to hyperkalemia=bad. Hope that's clear, I might have confused myself...

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Specializes in Flight RN, Trauma1 CVICU STICU MICU CCU.

the above sounds pretty correct. Another aspect to consider is that using bicarb for pH control only achieves a temporary effect. The hydrogen that is buffered by bicarbonate is expressed as CO2, so unless they can blow it all off, the pH will rise again.

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