Bicarb Gtt

Kitesurfing bum · Feb 8, 2013

1) Also useful for metabolic acidosis... because won't the HCO3 be low in that case?

2) Docs are different, not sure if there's a hard number where a gtt is started. Need to think of the whole clinical scenario and if bicarb is appropriate.

3) I guess it would be a lost cause if the pt was expired. Bicarb is certainly used in code situations with extreme acid-base imbalances.

4) I'm sure there are...

5) Need to look at everything. pH and HCO3. If you are replacing K, you don't just look at the EKG, you need to check the serum K.

Fun fact: CO2 from, say, a BMP is going to roughly correlate with the HCO3 from an ABG. Maybe there's a biochem champ out there who can explain that one to us...

meandragonbrett · Feb 8, 2013

Fun fact: CO2 from, say, a BMP is going to roughly correlate with the HCO3 from an ABG. Maybe there's a biochem champ out there who can explain that one to us...

Serum CO2 is a measurement of base whereas PCO2 is measurement of acid.

To the OP,

NaHco3 isn't always the most helpful thing to correct a respiratory acidosis unless the Ph is so acidic that the patient is critical/in trouble as a result of the Ph. You will see/hear lots of controversy by different providers regarding the use of NaHCO3 in resp. acidosis. Always want to look at WHY the patient is in resp. acidosis. What is causing the alveolar hypoventilation and is there a way that it can be corrected.

Chisca, RN · Feb 10, 2013

Bicarb drip for respiratory acidosis? Are you sure there isn't a metabolic component in addition to the respiratory problem? Either way a bicarb drip is a poor choice as the patient doesn't have a deficit of bicarb but rather an abundance of acid. I would recommend some form of dialysis, either CRRT or SLED, before a bicarb drip.

prep8611 · Feb 11, 2013

Bicarb drip for respiratory acidosis? Are you sure there isn't a metabolic component in addition to the respiratory problem? Either way a bicarb drip is a poor choice as the patient doesn't have a deficit of bicarb but rather an abundance of acid. I would recommend some form of dialysis either CRRT or SLED, before a bicarb drip.[/quote']
Here here

Esme12, ASN, BSN, RN · Feb 12, 2013

Another question from a student new to the ICU.
1) I have seen bicarb drips started for pts in respiratory acidosis with a lower than normal pH. Is it only resp acidosis in which this is useful?
2) At what pH would you consider starting a bicarb gtt/pushing bicarb? Just anything below 7.35?
3) Is there a point at which pushing bicarb or starting a drip is a "lost cause"?
4) Any other indications of why you would start a bicarb gtt or push bicarb?
5) Do you essentially keep checking ABGs, and stop the drip when the pH has corrected itself? I was following a new RN who said that you need to recheck the bicarb level to see if it is corrected, but this doesn't make sense...don't you want to check the pH, technically?
Sorry this is kind of a dumb question, but I can't find a lot of info in my text books. :/

Actually in my experience Bicarb drips are for metabolic acidosis. Pure respiratory acidosis is "cured" with hyperventilation or dropping the PCO2.

I think the "New Nurse" you were following is too new to help another student effectively.

Usually respiratory acidosis is caused by some type of hypoventilation and elevated HCO2 levels. When you finally ventilate/hyperventilate the patient and the PCO2 return to "normal" the acidosis resolves. Chronic CO@ retainers are technically in a state of constant resp acidosis that is compensated metabolically by the acid base buffers in the body.

Because the new nurse said check the "bicarb levels" it leads me to believe it is a metabolic acidosis she was dealing with.....and yes you check Ph and bicarb levels to prevent over correction which is harmful to the patient.

This site might help you figure it out....icufaqs.org

sleepy17 · Feb 18, 2013

Oh dear, I did mean metabolic, not respiratory! My apologies. Thank you all who have responded so far :)

hodgieRN · Feb 18, 2013

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.

turnforthenurse, MSN, NP · Feb 19, 2013

Bicarb isn't used as frequently in hyperkalemic states anymore, it seems...the typical treatment is regular insulin IV + D50 + calcium chloride + kayexalate. It's true that potassium leaks out in an acidotic state (hyperkalemia) but providers won't order a bicarb gtt unless the patient is acidotic. Too much of a pH change can be harmful. It's all about balance.

I have also seen cardiologists order a bicarb gtt (typically 150mEq bicarb in D5 at a rate of 3mL/kg/hr) to be started about an hour before a cardiac cath to prevent contrast-induced nephropathy, especially in patients with reduced renal function or if they have other risk factors (DM, which we all know diabetics typically have problems with their kidneys), certain meds, CHF & multiple myeloma).

hodgieRN · Feb 19, 2013

Correction...it's myopathy, not myelopathy. Myopathy is muscle, myelopathy is spine, neuro. Sorry