Bicarbonate Therapy in Severe Metabolic Acidosis

Posted by e-Medical PPT Sunday, October 17, 2010
The main goal of alkali therapy is to counteract the extracellular acidaemia with the aim of reversing or avoiding the adverse clinical effects of the acidosis.
Important points about bicarbonate therapy
1. Ventilation must be adequate to eliminate the CO2 produced from bicarbonate
Bicarbonate decreases H+ by reacting with it to to produce CO2 and water. For this reaction to continue the product (CO2) must be removed. So bicarbonate therapy can increase extracellular pH only if ventilation is adequate to remove the CO2. Indeed if hypercapnia occurs then as CO2 crosses cell membranes easily, intracellular pH may decrease even further with further deterioration of cellular function.
2. Bicarbonate may cause clinical deterioration if tissue hypoxia is present
If tissue hypoxia is present, then the use of bicarbonate may be particularly disadvantageous due to increased lactate production and the impairment of tissue oxygen unloading.
3. Bicarbonate is probably not useful in most cases of high anion gap acidosis
Lactic acidosis can get worse if bicarbonate is given. Clinical studies have shown no benefit from bicarbonate in diabetic ketoacidosis. In these cases, the only indication for bicarbonate use is for the emergency management of severe hyperkalaemia.
4. Bicarbonate therapy may be useful for correction of acidaemia due to non-organic acidosis
In non-organic acidosis, there is no organic anion which can be metabolised to regenerate bicarbonate. Once the primary cause is corrected, resolution of the acidaemia occurs more rapidly if bicarbonate therapy is used. Amounts sufficient for only partial correction of the disorder should be given. The aim is to increase arterial pH to above 7.2 to minimise adverse effects of the acidaemia and to avoid the adverse effects of bicarbonate therapy.
Metabolic Acidosis

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