Ditto on the resp vs metabolic
There are lots of indications for bicarb gtts (most of them have to do different acidic conditions that are metabolic in nature), but bicarb gtts can be used for treating of overdoses. If someone ODs on aspirin, bicarb gtts will alkalize the urine and possibly neutralize kidney damage. Pts with renal stents can take PO bicarb for alkaline urine. You use it for tricyclic antidepressant overdose. You use it for rhabdomyolysis (which is caused by crush injuries, anesthesia, toxic metals, snakes bites, cocaine, and statins like simvastatin. Did you know simvastatin can cause rhabdo? Most people know statins can make your liver enzymes go up, but pts who complain of muscle pain with statins...not good! It's called myelopathy and rhabdo is right around the corner). And if you wanted to get technical with acidic conditions, you could include DKA, uremia, lactic acidosis, etc. DKA would get bicarb gtts, but uremia and lactic acidosis wouldn't unless there is some kind of extreme acidosis. And any pt with kidney damage or failure has issues with acidosis because bicarb is secreted by the kidneys. Kidney failure pts have to take PO bicarb (many of them at least).
Look up the acronym M.U.D.P.I.L.E.S. It's a list a acidic metabolic conditions.
We used to use bicarb during a code blue, but that is now a class III, meaning don't give it. The evidence states that bicarb does not improve outcomes during CPR.
Bicarb is a great drug for hyperkalemia. You give insulin, dextrose, and bicarb all IV push and that will lower serum potassium. The bicarb will drive the potassium back into the cell where it belongs. Did you know that an hour long albuterol treatment lowers serum potassium? Cool, huh? So if you want to look smart and a practitioner asks you the how to lower potassium without injecting all this IV stuff, say albuterol treatment. They will be impressed. Also, pt that are on bicarb gtt can have their potassium drop... and I mean drop. If someone is on a gtt, you better be monitoring the BMP.
As posted before, the CO2 level on the BMP closely reflects the bicarb level on an ABG. The only real way to check the PH is by ABG.
Bicarb is mainly used when the respiratory center can not correct the imbalance or there is a major condition occurring. It's not always best to jump straight to bicarb. Med students often make this mistake. Bicarb should never be used as a quick fix for a lab readout. The condition needs to be addressed...don't use bicarb to make the Ph look pretty....like when bicarb is used to treat acidic Ph caused by respiratory depression.