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Intravenous sodium bicarbonate, also known as sodium hydrogen carbonate, is a medication primarily used to treat severe metabolic acidosis. [2] For this purpose it is generally only used when the pH is less than 7.1 and when the underlying cause is either diarrhea , vomiting , or the kidneys . [ 3 ]
Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance.Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. [5]
Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate (HCO − 3), or alternatively a direct result of increased bicarbonate concentrations.
[1] [2] Hyperkalemia can cause an abnormal heart rhythm which can result in cardiac arrest and death. [1] [3] Common causes of hyperkalemia include kidney failure, hypoaldosteronism, and rhabdomyolysis. [1] A number of medications can also cause high blood potassium including spironolactone, NSAIDs, and angiotensin converting enzyme inhibitors. [1]
Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. [1] In renal physiology, when blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid equivalents, and other solutes before it drains into the bladder as urine.
Metabolic acidosis, hyperkalemia, and pulmonary edema may require medical treatment with sodium bicarbonate, antihyperkalemic measures, and diuretics. [33] Lack of improvement with fluid resuscitation, therapy-resistant hyperkalemia, metabolic acidosis, or fluid overload may necessitate artificial support in the form of dialysis or ...
In those with severely low blood pH who are critically ill, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. [1] [6] Rates of DKA vary around the world. [5] Each year, about 4% of type 1 diabetics in the United Kingdom develop DKA, versus 25% of type 1 diabetics in Malaysia.
[4] [10] Once urine output is established, sodium bicarbonate and mannitol are commonly used but they are poorly supported by the evidence. [3] [4] Outcomes are generally good if treated early. [3] Complications may include high blood potassium, low blood calcium, disseminated intravascular coagulation, and compartment syndrome. [3]