Sodium Bicarb question!

Spatialized · Mar 31, 2007

Hi, I have a question, I asked a few other people (nurse and pharmacist) but they all told me the same general answer.
My pt. was admitted with c/o chest pain he calls it "chest pressure". He is going for a cardiac cath on Monday. The cardiologist put an order in for D5 in water with 8.45% sodium bicarb. at 150 ml/hour to start on Sunday night, the night before his Cardiac cath.
What is the logic for this? I know it's to fix metabolic acidocis. His labs are not acidotic. and that's the answer everyone keeps saying..."oh it's to fix metabolic acidosis". I can't figure it out. Can anyone please help me figure this out?
He really doesn't have much of a significant history.. arthritis, back pain...

Sounds like a protocol we have to prevent contrast induced nephropathy in our cath lab patients. The docs will order if based on the patient's labs, mainly their BUN and creatinine, but also age and other comorbidities, like diabetes that may predispose them to taking a bigger hit from the contrast used in cardiac catheterization. Also, I believe that if the docs figure there are multiple lesions that need stenting, they may order the bicarb because more stents will usually mean more contrast dye.

Here's a couple of links, one supports the use of sodium bicarb, the other from the latest ACC meeting says the results are not really that much better than just NS.

http://kidneydiseases.about.com/b/a/007178.htm

or

http://www.medpagetoday.com/Cardiology/2005ACCMeeting/tb1/5344

There's also much more info on the subject as well. You can google "contrast-induced nephropathy".

Cheers,

Tom

oMerMero · Mar 31, 2007

renal protection due to the contrast

lysh7777 · Apr 2, 2007

Thanks so much~