Date Published

November 2, 2023

Updated For

ALS PCS Version 5.2


Sodium Bicarbonate in the ACP Scope: When to consider calling

As you may recall, you may patch to a BHP to consider administering sodium bicarbonate.​

The evidence for using sodium bicarbonate outlined by the AHA (2020) are in the following scenarios:​

  • Cardiac arrest due to known or suspected hyperkalemia and other causes of acidosis​
  • Cardiac conduction delays due to sodium channel blocker/tricyclic antidepressant (TCA) overdose​

Let’s review these a little bit further​


Potential Benefit: HyperK ​

Consider patching for sodium bicarbonate when Hyperkalemia is a known or suspected cause of arrest (think: missed dialysis, for example).​

In addition to IV calcium & salbutamol ​

Aim to rapidly correct acidemia


Potential Benefit: Other Acidosis Causes​

Potential causes of acidosis that can lead to cardiac arrest (and prompt consideration to patch for bicarb):​

  • Sepsis​
  • Diabetic Ketoacidosis ​
  • Excited Delirium ​
  • ROSC with Re-arrest​

Note: Acidemia is a dynamic process which is best managed by high-quality CPR, early defibrillation, and an additional benefit of ventilation.


Potential Risks​

The AHA (2020) guidelines does not recommend the routine use of sodium bicarbonate for patients in cardiac arrest:​

  • There is no evidence for improved outcomes​
  • Evidence suggests it may worsen survival and neurological recovery​

Additional risks associated: ​

  • Hypernatremia​
  • Hyperosmolality​
  • Intracellular acidosis ​
  • Extracellular alkalosis​
  • Reduced cardiac output​
  • Inactivation of catecholamines (administered simultaneously)​

Potential Risks​

Consideration for the administration of sodium bicarbonate is multifactorial – there are some potential benefits and associated risks. A BHP patch is required.​

Now you know the evidence-backed reasons to call and why you may or may not receive the order!



Additional Resources:

The SWORBHP Podcast (Also available on Apple Podcasts, Google Podcasts, Amazon, and Spotify)

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