When do you prefer to give bicarb

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Specializes in Internal medicine/critical care/FP.

I have seen many different articles written on this subject, and our critical care and nephrology staff vary on when, where, and how they decide to give bicarb for the different acidoses, (lactic, DKA, crf, various drug OD causes, etc).

I a not super preppy on giving it to patients, unless their ph is less than 7.1, or 6.9 with DKA. our pulmologists seem a bit more generous in giving bicarb, they seem to give with 7.2 and below (in lactic acidosis anyway)

What is you alls take on this. For me, unless they are severely acidotic and maxed out on respiratory compensation, or have acidosis from RTA 1 and 2, i just don't like giving it too often... unless their K is high of course.

Thanks for the input folks, I am sure there are some great ccu NPs on this forum, I of which am not one of them. lol.

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

For most MICU patients, a pH less than 7. I would be cautious to give Sodium Bicarbonate to a patient who does not have the ability to ventilate off the rise in pCO2 from the administration of Sodium Bicarbonate. I also prefer to give the Sodium Bicarbonate as an infusion rather than as a bolus.

There are other options, such as THAM, in patients with intact urinary output production. In cases where I feel that the additional volume of Sodium Bicarbonate infusion will compromise a patient who is already fluid overloaded, I would consult Nephrology and get an order for CRRT. I will place the dialysis catheter. Our ICU nurses can do CRRT 24/7.

In our Cardiothoracic Surgery population, there is a lower threshold to give Sodium Bicarbonate as the heart that was just operated on poorly tolerates acidemia. If the pH couldn't be corrected via increased ventilation, I would give Sodium Bicarbonate more readily there.

Sodium bicarbonate versus THAM in ICU pati... [J Nephrol. 2005 May-Jun] - PubMed - NCBI

Bicarbonate Therapy in Severe Metabolic Acidosis

http://circ.ahajournals.org/content/29/3/456.full.pdf

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Specializes in Internal medicine/critical care/FP.

Thanks a bunch I'll read over these

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