Bicarb Dilemma: Hero or Hype in the ED?
Is sodium bicarbonate (NaHCO3) a lifesaver or a risky move in Emergency Medicine? Explore this pivotal infographic from Dr. Salha Mohd Fadil, endorsed by the College of Emergency Physicians Malaysia. Based on the BICAR-ICU Trial and Surviving Sepsis Campaign 2021, discover when to act and when to hold back!
Key Insights: NaHCO3 Decisions
In Cardiac Arrest
Routine use not recommended. Consider for hyperkalemia or drug overdose.
Reference: Lavonas, Eric J., et al. "2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation, vol. 148, no. 16, 17 Oct. 2023, pp. e153-e183, doi:10.1161/CIR.0000000000001161
In Sepsis
Avoid for septic shock with lactic acidosis unless pH <7.2 and AKIN Score 2/3.
Reference: Evans, Laura, et al. "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021." Critical Care Medicine, vol. 49, no. 11, Nov. 2021, pp. e1063-e1143. LWW Journals, doi:10.1097/CCM.0000000000005337
In Metabolic Acidosis
No overall benefit. Potential benefit in severe AKI, but needs more study.
Reference: Jaber, Samir, et al. "Sodium Bicarbonate Therapy for Patients With Severe Metabolic Acidaemia in the Intensive Care Unit (BICAR-ICU): A Multicentre, Open-Label, Randomised Controlled, Phase 3 Trial." The Lancet, vol. 392, no. 10141, 7 July 2018, pp. 31-40. DOI.org (Crossref), doi:10.1016/S0140-6736(18)31080-8
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