Isotonic Bicarbonate (150 mEq/L) Hypertonic bicarbonate (1 mEq/mL) % NaHCO 3 by weight ~1.3% NaHCO 3 8.4% NaHCO 3 Tonicity 300 mOsm 2,000 mOsm General properties - Doesn’t cause hypernatremia - Large volume required to increase bicarb. - Will decrease potassium concentration. - Doesn’t cause significant volume load - Will increase sodium concentration - Doesn’t affect potassium concentration Use - Volume resuscitation in patient with acidosis - Hyperkalemia - Metabolic acidosis in patient with euvolemia - Emergency treatment of hyponatremia - Emergency treatment of cerebral edema Cautions - Excess may cause volume overload and hypokalemia - Excess will cause hypernatremia - Administer slowly to avoid significant pCO2 rise - The Internet Book of Critical Care, by @PulmCrit