Acidotic patients

[Go-GetterRN]

Hey everyone,

I work in a large med-surge icu in a metro area. We take some trauma, not a lot, but i feel like this question is most appropriate for trauma icu nurses.

In our icu, we get a lot of patients post cardiac arrest, with bleeds, OD, etc where their condition causes them to be severely acidotic (worst I've seen is pH 6.9.) Anyways, these patients are typically maxed on a few pressors and we push bicarb to increase their pH because none of the meds we give are effective in such an acidotic state. I want to know what exactly about the acidotic state causes the meds to not work?? I have done a lot of research on this, but can not find a detailed answer. I'm guessing it has something to do with enzymes in the body that normally help the body process these meds, that don't work in an acidotic environment, but I'm not ever basing my nursing practice off of guesses. If anyone can give a detailed answer on this and maybe post a source please do so!!

[mwlude]

Conformational changes in all proteins within the body, of main concern would be albumin and as you stated enzymes, also membrane bound receptors (usually all protein based). Ion shifts r/t acidosis can cause abnormal binding which may change chemical structures. Couple these factors with all other manifestations of the original disease process which caused the acidosis to begin with (i.e. hypovolemia..poor global distribution/perfusion).

[Go-GetterRN]

Ok, thanks for the answer!

[ICUPrincessNurse]

I was typing mine out. Then read the above. So yeah. What he said.

There's something magical about a pH of 7.2 that seems to magically make meds work.