IV fluids

In my experience it's generally used (rarely) for a patient that is very acidotic (as in imminent danger of death from it) in the critical care or during an arrest that has gone on a long time.

Because bicarbonate is a acid buffer, I would think it would be used for metabolic acidosis. You would want to increase alkalinity in the body. HMMM You might also give it to keep the urine Ph levels normal to prevent acidity which can cause uric acid crystallization. Any other thoughts from you guys?

In my experience it's generally used (rarely) for a patient that is very acidotic (as in imminent danger of death from it) in the critical care or during an arrest that has gone on a long time.

Yes, we use it for just this reason. Although, it's not that rare for us to use it. Maybe it's because it's a teaching hospital?

We use LR a lot for more stable acidotic pts. Like DKA. Something that is an acidotic state but not on the level of dying pt.

I also worked in a teaching hospital, however outcomes were shown not to be improved when bicarb was used (from my understanding) so it was only used in extreme situations.

I agreed with you. It's just that we have a lot of pts who come in with extreme met acidosis, like tons of people found down in the desert. I may have someone on a bicarb ggt once a week. So it's rare, but not extremely rare, KWIM?

Well, I'm definitely not near a desert, so maybe that's it!