Prevalence of sodium bicarbonate-induced alkalemia in cardiopulmonary arrest patients.
BACKGROUND
Intravenous sodium bicarbonate (SB) administration during cardiopulmonary arrest (CPA) is intended to counteract lactic acidosis due to hypoxia, poor perfusion, and anaerobic metabolism. Despite a lack of documented efficacy and a level III recommendation from the American Heart Association, SB is widely used during resuscitation events. SB has both theoretical and measurable adverse effects. Excess or poorly timed administration during a CPA may elevate a patient's pH, inducing alkalemia. Despite decades of controversy surrounding use of this drug, the prevalence of SB-induced alkalemia has not been previously documented.


OBJECTIVE
To estimate the prevalence of SB-induced alkalemia in inpatients after CPA and to investigate the pattern of SB administration.


METHODS
Medical records were retrospectively reviewed with attention to SB administration and arterial blood gas (ABG) data. After application of inclusion and exclusion criteria to 264 CPA patients, the study group comprised 88 patients. When measured, if PCO(2) and pH were above normal limits after SB administration, we concluded that SB contributed to the alkalemia.


RESULTS
Twenty-seven (31%) patients received SB without any ABG data, and 70 (79%) patients received at least one empiric SB dose. Of the 61 patients with ABG data, alkalemia occurred in 10, a prevalence of 16%. Administration of SB increased pH in only 9 (15%) other CPA patients and had no effect in the 42 (69%) remaining patients.


CONCLUSIONS
Administration of SB during CPA was causally linked with inducing alkalemia in 16% of patients. Early collection of ABG samples may assist in optimizing pH during CPA and thus reduce unwarranted empiric use of SB.
Geraci
Matthew J
MJ
Emergency Medicine, Baptist Medical Center Downtown, Jacksonville, FL, USA.
Klipa
Dusko
D
Heckman
Michael G
MG
Persoff
Jason
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000471:Alkalosis / Q000139:chemically induced* / Q000453:epidemiology; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000097:blood; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D002245:Carbon Dioxide; D017693:Sodium Bicarbonate