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):
- 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.
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:
- Intracellular acidosis
- Extracellular alkalosis
- Reduced cardiac output
- Inactivation of catecholamines (administered simultaneously)
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!