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Discussion

Bicarbonate!!!!

Hi guys

I'm being really stupid, I know, but I'm reviewing my IV fluids (hypotonic/isotonic etc) and why certain things are used at certain times. I'm having trouble with one patient I had in clinical. He had a MIV with bicarb in it, and I don't know why. What does it do and when is it used for a maintenance? This guy was D5W with 2 amps NaHCO3. I know I should know why, and it's probably really simple, but it's not making sense! Can someone please help?? THANK YOU!!!!

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What were his clinical problems? Was he in DKA? Is he a hemo pt? Was he an ASA overdose?

Need more info...

Alot of times people need bicarb to correct their PH......their blood may be on the acidic side for whatever clinical reason (there are many possibilities here), also I think sometimes people get bicarb to buffer the kidneys........but the reason a person would recieve it can be very individual.

Hi guys

I'm being really stupid, I know, but I'm reviewing my IV fluids (hypotonic/isotonic etc) and why certain things are used at certain times. I'm having trouble with one patient I had in clinical. He had a MIV with bicarb in it, and I don't know why. What does it do and when is it used for a maintenance? This guy was D5W with 2 amps NaHCO3. I know I should know why, and it's probably really simple, but it's not making sense! Can someone please help?? THANK YOU!!!!

Sometimes you use a bicarb gtt like that as kidney protection for testing prep. We use it on any pt who is going for CT with IV contrast. Would need more info to see if this would qualify in your situation.

  • Author

Thanks guys - sorry I didn't give more info before. I had this guy awhile back and I don't remember all his info. He had cancer - I think mets with unknown primary at the time I was there. He hadn't started any chemo yet and as far as I remember his labs were mostly okay. There were some things off in his CBC/diff but mostly it was like RDW and stuff that we didn't really deal with in clinical. I thought of the renal protectant thing, but since I don't know what the plan was going to be for chemo for him, I really don't know. That was the only thing I could think of, but since I never got to follow up with him, I really don't know what happened. Thanks again for the replies!

Could be a lot of reasons

Prevention and management of tumor lysis syndrome

Acidosis management (renal tubular acidosis?)

renal disease and need for IV contrast

Hyperkalemia

Chemotherapy (methotrexate?)

  • Experts

i looked this up in my copy of intravenous therapy: clinical principles and practice, by judy terry, leslie baranowski, rose anne lonsway and carolyn hedrick. it is given to correct metabolic acidosis that may have been caused by renal disease or heart attack and severe hyperkalemia where it helps to shift potassium into the cells. it is an alkalizing agent with a sodium salt. the bicarbonate ion separates and becomes a buffer in the body's extracellular fluid space helping to maintain osmotic pressure and the acid-base balance. it will, hopefully, keep the body's ph within a normal range while it has a chance to compensate using its other body mechanisms. the sodium antagonizes the cardiac effects of the potassium as well as further encouraging the potassium to shift into the cells. complications of administering sodium bicarb include metabolic alkalosis , hypocalcemia, hypokalemia, and hypernatremia with fluid retention.

  • Author

Thanks, guys! My buffer theory is making more sense now that the rest of you are agreeing with me! I just thought I was missing something!

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