Who wants a bicarb question?

labman · Oct 29, 2008

How does bicarb increase bp during a code? Is it just increasing CO and Why is the effect so short lived (pun or no pun)?

Personally I have never heard of bicarb used to increase the blood pressure in a code. The reason it is given is to increase bicarb because hypothetically if you code (stop breathing the patient will become acidotic from too much CO2

aCRNAhopeful · Oct 29, 2008

I'm no ICU nurse (yet) but acidotic states usually cause vasodilalation so one could assume reversing that with bicarb would help to raise BP. Besides that its used for other reasons in a code like causing potassium to shift back into the cells to reverse hyperkalemia (those patients are usually acidotic too) and I'm sure many other reasons but I'm a student and don't know them.

SFRN · Oct 29, 2008

Hi I work in a surgical cardiac (adult) and I have never given bicarb to increase BP in a code---I have given epi., atropine, and vasopressin and of course titrated up on gtts like Levo, epi, neo, etc. I have given it to reverse (as mentioned) a high K. When giving bicarb you def. see an increase in BP and CO for that matter but it is generally transient. I have also seen it given for acidotic patients. But it is important to remember that you should good control of your airway and ventilation because bicarb breaks down into h20 and c02 hence may increase acidosis if you do have adequate ventilation--I saw this more than once when I worked in the Neonatal ICU.....hope this helps!

mmbmoc · Oct 29, 2008

My two cents....maybe we shouldn't look at bicarb's mechanism of action to increase BP...instead, we should maybe consider that bicarb helps buffer the acidity content in the bloodstream. Why is this important? Well, pressors will not effectively work in a human body when you pH is less than 7.1, so no matter how much levo or epi you give, it's not serving it's purpose. Correcting your pH when administering bicarb to a patient may assist in making the emergent medications such as dopamine, levo, epi work effectively in the body. Like I said, just my two cents. :twocents:

jamieblu · Oct 29, 2008

Agree... The rationale for giving bicarb in a code is to correct acidosis. No breathing, means too much acid--bicarb can help correct this (in addition to ventilation).

Hey SFRN-- Just out of curiosity, I would like to move to SF after school (many moons from now). Is there a demand for CRNA's in SF?

Jolie, BSN · Oct 29, 2008

I am not familiar with giving bicarb to increase B/P, but that may be a desirable side effect of the drug.

Bicarb is hypertonic and may bring about a fluid shift that leads to increased B/P.

gluck · Oct 29, 2008

I like your thinking mmboc, ... I know it doesn't make it right, ... but i like it!

So, Assume the pt is getting all kinds of fluid, products, and pressers, but the increased BP clearly correlates with and dies with the bicarb

I don't recall the mechanism, but know bicarb can increase CO. Yet i've seen dramatic BP increases that seem like they must be due to more than increased CO.

Anyone else?

RNgirlie · Oct 29, 2008

we give bicarb for acidosis

allnurses Guide · Nov 1, 2008

Found a somewhat old, but interesting article:

Cooper DJ, Walley KR, Rnssel JA (t990) Bicarbonate does not improve

hemodynamics in human lactic acidosis: a prospective, controlled

study. Ann Intern Med 112:492-498

Postulates that the increase in CO is due to the hypertonicity improving LV preload, rather than an increase in contractility or any other reason for increasing BP.

Phishininau · Nov 4, 2008

Bicarb accounts for 50% of the body's buffering system. When a patient is in a low output state, lactic acidosis, or anaerobic metabolism, increases. The increase in acid content will cause a decrease in cardiac output that in some cases can be refractory in treatment. Bicarb administration will increase the buffering content of the blood for a brief time, and other treatments will be more effective. I have actually seen an increase in SVR and MAP with the use of bicarb in a patient that was "maxed" out on pressors, but if the heart is not beating and circulating said pressors, there wont be a response.

Many nurses I worked with advocated the use of bicarb in the severely acidotic patient as a stop gap to other treatment, and for that it can be effective in the short term. However, you must consider that with the infusion of large amounts of bicarb, > 100mEq in a single bolus, you can cause hypernatremia and shifts in serum osmalality that will get you in more trouble that you were in to start with.

SFRN · Nov 29, 2008

If you have a situation where you need a buffer but the pt. has a high sodium then one can use THAM.

Bicarb accounts for 50% of the body's buffering system. When a patient is in a low output state, lactic acidosis, or anaerobic metabolism, increases. The increase in acid content will cause a decrease in cardiac output that in some cases can be refractory in treatment. Bicarb administration will increase the buffering content of the blood for a brief time, and other treatments will be more effective. I have actually seen an increase in SVR and MAP with the use of bicarb in a patient that was "maxed" out on pressors, but if the heart is not beating and circulating said pressors, there wont be a response.
Many nurses I worked with advocated the use of bicarb in the severely acidotic patient as a stop gap to other treatment, and for that it can be effective in the short term. However, you must consider that with the infusion of large amounts of bicarb, > 100mEq in a single bolus, you can cause hypernatremia and shifts in serum osmalality that will get you in more trouble that you were in to start with.