Cite this post as:
Scott Weingart, MD FCCM. Podcast 97 – Acid-Base VI – Chloride-Free Sodium. EMCrit Blog. Published on May 2, 2013. Accessed on October 2nd 2022. Available at [https://emcrit.org/emcrit/chloride-free-sodium/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: May 2, 2013
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Maalox is cheaper than bicarb for smelly feet
Messier though. I like just squirting the bicarb on the socks from afar.
Did you mention bicarbonate use in salicylates ?
Great Add Ben!
Pre-intubation reasons???
Ummm, that was addressed in the last podcast. It doesn’t work for that purpose.
Hi Doc, curious. The podcast done last year with the LVAD gents from CA stated CPR wasn’t necessarily contraindicated with LVAD placement. But the new REMAC protocol is very specific about chest compressions not being done. Has there been a change in the science or new data in regards since the original podcast?
Thank you.
All depends on who you ask.
Doc, here is my expanded thoughts on crush injuries while you await response from Cliff Reid.. I’ve been taught, but never done it, that patients with an entrapped limb need to get 50-100mEq prior to compression being removed via push dose, or drip to combat potential hyperkaeleimia, and otherwise, general acidosis from the cell death that has occurred in the entrapped limb. Post push dose, or drip dose of sodium bicarb, we were always instructed to do 50mEq per L of saline, and infuse it over an hour. My thoughts are… A. Is it underdosed? B. Does it actually solve… Read more »
Hi Ryan
I frequently debate this with colleagues. In the absence of evidence, we end up agreeing to disagree.
My view is that the practice of infusing bicarbonate prior to release of an entrapped victim in order to prevent dysrhythmia is bollocks.
Happy to go into more detail as to why if you like.
Cheers
Cliff
Cliff,
After listening to the past two shows, I feel like I can understand why it likely won’t work, but, I’d love to have you expand on it. Ether on Scott’s show, or here…
Thanks!
Cliff,
Mechanistically, it would seem to make more sense to give these folks an amp of CaCl before removing the objects from crushed extremity. Is anyone doing this?
s
Our protocols recognize both 1g CaCl and 1-2 amps NaBicarb prior to releasing a crush-injured patient.
I finally had a chance to review our protocols after my vacation….ours simply states, 50mEq in 1000mL bag of NS, infuse W/O…nothing further as to why, when, or followup after…
I’ll have to look into this and see if this got missed on our last revision.
HI
I have learn from the PHTLS 2007 that patient with crushed injuries need calcium + sodium bicarbonate 1 amp/1L prior to compression being removed. That is because of the large released of potassium and myoglobin from the muscle intracellular space of the crushed tissue in the circulation. The bicarbonate is used to alkalised the urine and prevent the formation tubular casting from myoglobinuria.
Is this still make sense?
There’s a podcast who talks about it too
http://burndoc.libsyn.com/traumatic_rhabdomyolyisis_crush_syndrome
thanks
Hi Scott.
When you give bicarbonate as a push over 10 minute push, how do you have it administered? Do you have the nurse stand there and do it?
Oops, just listened again and heard the 2 amps in 100 mL NS.
Hi Scott, I’m an emergency medicine resident and I had an odd situation the other day. Patient with past medical history of diabetes and chronic pancreatitis came in with nausea, hematemesis, and abdominal pain. Workup showed a blood sugar of 563, hypokalemia, hyponatremia, hypochloremia, an anion gap of 15, ketones and glucose in the urine but no acididosis (albumin was around 4, coags were normal). I know there are a few conditions that can cause an elevated anion gap without an acidosis, though I’m not sure what the cause was here, but more importantly, would you treat this as DKA?… Read more »
NaHCO3 150 mEq stable in refridgerator for a week when mixed in a polyolefin/Excel/PAB bag.
Stability of sodium bicarbonate solutions in polyolefin bags.
Wear J, McPherson TB, Kolling WM.
Am J Health Syst Pharm. 2010 Jun 15;67(12):1026-9. doi: 10.2146/ajhp090301. Erratum in: Am J Health Syst Pharm. 2010 Oct 1;67(19):1586.
PMID:20516474
Extended Stability of Sodium Bicarbonate Infusions Prepared in Polyolefin Bags
AUTHOR(S)Sayre, Brian E.; Prettyman, Terrence; Kaushal, Gagan
SOURCEHospital Pharmacy;Jul2012, Vol. 47 Issue 7, p538
Hi Scott,
In the podcast you mention a magical concoction of insulin, dextrose, calcium, and bicarbonate used in a pediatric study to treat hyperkalemia – any chance you could post the reference? I’ve been looking for the article but can’t seem to find it. It sounds like a great way to treat hyperkalemic patients, especially if they make urine and you can give some lasix as well. I wanted to see what their recipe for the IV drip was to see if I could translate it to my adult patients. Thanks!
Hello EMCrit Crew, I’m not sure if you still reply to comments this far back but I had a question on the use of Sodium Bicarbonate for hyponatremic seizures. Speaking prehospitally, If you had a patient with seizures refractory to benzos, and reason to suspect hyponatremia as the cause, could prophylactic use of Nabicarb be justified? What are other potential etiologies I could disturb if the cause was not due to hyponatremia?
Thanks a lot