title: Sodium bicarbonate causes dose-dependent increases in cerebral blood flow in infants and children with single-ventricle physiology.
abstract: BACKGROUND
  Sodium bicarbonate (NaHCO3) is a common treatment for metabolic acidemia; however, little definitive information exists regarding its treatment efficacy and cerebral hemodynamic effects. This pilot observational study quantifies relative changes in cerebral blood flow (ΔrCBF) and oxy- and deoxyhemoglobin concentrations (ΔHbO2 and ΔHb) due to bolus administration of NaHCO3 in patients with mild base deficits.
  
  
  METHODS
  Infants and children with hypoplastic left heart syndrome (HLHS) were enrolled before cardiac surgery. NaHCO3 was given as needed for treatment of base deficit. Diffuse optical spectroscopies were used for 15 min postinjection to noninvasively monitor ΔHb, ΔHbO2, and ΔrCBF relative to baseline before NaHCO3 administration.
  
  
  RESULTS
  Twenty-two anesthetized and mechanically ventilated patients with HLHS (aged 1 d to 4 y) received a median (interquartile range) dose of 1.1 (0.8, 1.8) mEq/kg NaHCO3 administered intravenously over 10-20 s to treat a median (interquartile range) base deficit of -4 (-6, -3) mEq/l. NaHCO3 caused significant dose-dependent increases in ΔrCBF; however, population-averaged ΔHb and ΔHbO2 as compared with those of controls were not significant.
  
  
  CONCLUSIONS
  Dose-dependent increases in cerebral blood flow (CBF) caused by bolus administration of NaHCO3 are an important consideration in vulnerable populations wherein risk of rapid CBF fluctuations does not outweigh the benefit of treating a base deficit.
authors: Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. buckley@nmr.mgh.harvard.edu
authors: Erin M
authors: EM
authors: Buckley
authors: Maryam Y
authors: MY
authors: Naim
authors: Jennifer M
authors: JM
authors: Lynch
authors: Donna A
authors: DA
authors: Goff
authors: Peter J
authors: PJ
authors: Schwab
authors: Laura K
authors: LK
authors: Diaz
authors: Susan C
authors: SC
authors: Nicolson
authors: Lisa M
authors: LM
authors: Montenegro
authors: Natasha A
authors: NA
authors: Lavin
authors: Turgut
authors: T
authors: Durduran
authors: Thomas L
authors: TL
authors: Spray
authors: J William
authors: JW
authors: Gaynor
authors: Mary E
authors: ME
authors: Putt
authors: A G
authors: AG
authors: Yodh
authors: Mark A
authors: MA
authors: Fogel
authors: Daniel J
authors: DJ
authors: Licht
mesh_terms: D002560:Cerebrovascular Circulation / Q000187:drug effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017693:Sodium Bicarbonate / Q000494:pharmacology*
chemical_list: D017693:Sodium Bicarbonate
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