Sodium Bicarbonate -- bad for acidosis?

[nursingjudgment]

I am a new nurse and am doing an ICU "bridge program" with nurse educators at my hospital. Most recently, they said that sodium bicarbonate shouldn't be used to treat acidosis because high CO2 levels cause our respiratory drive, so if we decrease acid levels with bicarb, we can cause a problem even worse than our original one.

Yesterday I had a patient who had a pH of 7.09. We were (as one might expect) running bicarb like mad. We were hyperventilating him (RR of 24 on the vent) as well. Now obviously on this patient we didn't have to worry about the respiratory drive (since he was vented), but it still made me wonder about my educator's statements about bicarb. Do your hospitals use it? Is there something to what my educators said? I feel as though it is fairly standard for doctors on my unit to prescribe.

[FlyingScot, RN]

Medscape: Medscape Access

You will note that it is mentioned that a side-effect of treatment with NaHCO3 is a rise in PaCO2 which is an issue with patients who have ventilatory issues. What this means is that patient with compromised or inefficient respirations will not be able to blow off the extra CO2 that comes from alkali treatment which will cause worsening acidosis. I am not at all clear on what your instructor said exactly but it does not seem correct to me.

[nursingjudgment]

Thanks, FlyingScot, that link was so helpful! I have a feeling that this is what my instructors were trying to say but didn't. I don't want to criticize my bridge program, but it often feels as though they are saying things that aren't quite right. The other day one of my instructors said that we have CSF in our peripheral nervous system...

So it seems the upshot is that alkali (usually bicarb) tx should be considered in patients with pH

Thanks, again! I understand this much more thoroughly now.

[dah doh, BSN, RN]

Bicarb gtt is used to treat severe metabolic acidosis such as single digit bicarb levels with very low pH. Letting the CO2 levels rise too high only leads to ALOC and bipap or intubation.

[AngelRN27]

Hmmm... not sure exactly what your preceptor meant, but in the clinical example you presented, everything sounds right. The interventions you mentioned (administering bicarb/initiating bicarb drip + increasing RR on vent) seem standard to me, especially for that pH. I would have to agree with FlyingScot's response.... but in this case we have more control because the pt is already on a vent...

It all depends on the pt and the context.