US National Library of Medicine NIH: Sodium Bicarbonate Case Study

[DesertMedic66]

Every single patient I gave bicarb to died... push or drip... many of them... usually not right away, but within days, weeks...
There's your ICU anecdote of the day. I think it is a great temporizing measure.
I think it was more of a message that those patients that received had associated insult from the profound acidosis or its etiology that it was unsurvivable.

My girlfriend has had the same experience with it in the ICU setting.

 

[Carlos Danger]

I think even normal human physiology is far more complex than most of us appreciate, nevermind maladapted physiology, which is even more complex still. There are many interventions that are perfectly rational hypothetically, but in actual practice end up not helping or even being harmful. Administering an alkalinizing agent in order to normalize serum pH makes perfect sense, until you realize that it has a whole host of effects in addition to raising the pH.

 

[VFlutter]

Administering an alkalinizing agent in order to normalize serum pH makes perfect sense, until you realize that it has a whole host of effects in addition to raising the pH.

So given the often under appreciated effects of Bicarb administration do you think it is warranted or should still be avoided in the severely acidotic patient whom either arrests or is hypotensive refractory to pressors?

 

[Carlos Danger]

So given the often under appreciated effects of Bicarb administration do you think it is warranted or should still be avoided in the severely acidotic patient whom either arrests or is hypotensive refractory to pressors?

I wouldn't say it never has a role, but I don't think the evidence supports it in pretty much any case. Personally, I generally think of bicarb for pH as a hail mary that your don't toss up until you've reached the point that you have nothing to lose.

That said, I was involved in a case not too long ago where we had a severe postpartum hemorrhage that eventually required an emergent hysterectomy, but not until the surgeons spent way more time than they should have trying to stop the bleeding while salvaging the uterus. We replaced the entire blood volume several times (literally used all the blood products in the hospital) and gave her several doses of bicarb based in her ABG and it really did seem to help clinically. But that was the only time I remember ever giving it for acidosis and feeling like it really made a net positive difference. Like Summit said, almost anyone I've ever had to give bicarb to died.