Although short-term studies show a benefit from oral bicarbonate therapy
, long-term safety data are lacking.
Sodium bicarbonate therapy
for prevention of contrast-induced nephropathy: A systematic review and meta-analysis.
Intravenous sodium bicarbonate therapy
in severely acidotic diabetic ketoacidosis.
Increased BWC (Brain Water Content) was observed only in DKA mice that received combined insulin and bicarbonate therapy
, suggesting that rapid systemic alkalinisation in the presence of insulin may contribute to DKA-CE.
What are the Clinical Significance of Oxime and Sodium Bicarbonate Therapy
for Acute Organophosphate Poisoning?
An unexplained normal anion gap metabolic acidosis and the response to the bicarbonate therapy
confirms the diagnosis.
Caution is advised with bicarbonate therapy
since hypocalcaemia, hypernatraemia, systemic alkalosis and potential tetany are potential adverse effects.
It is important to differentiate from other causes of hypokalemia like familial periodic paralysis (FPP), thyrotoxicosis, hyperaldosteronism and gastrointestinal loss; because the treatment is different and bicarbonate therapy
can deteriorate familial hypokalemic periodic paralysis; on the other hand it is the mainstay of therapy in RTA.
Several of the key elements to patient management include: 1) During mechanical ventilation, target tidal volume at 6mL/Kg per ideal body weight or less, 2) maximize plateau pressure at 30 cm H20 or less to prevent volume induced lung injury, 3) allow for permissive hypercapnia to achieve the pressure and volume targets, 5) set PEEP to avoid alveolar collapse since alveolar de-recruitment leads to high alveolar opening pressures and lung damage, 6) minimize the use of pulmonary artery catheters due to no evidence based benefit, 6) use bicarbonate therapy
if pH is < 7.
was associated with a quadrupled risk for cerebral edema in the study of 416 patients, Dr.
She was treated with fluid, diuretics, and bicarbonate therapy
is controversial in treating DKA because of the potential consequences versus benefits.