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Sodium Bicarbonate..another weapon to control High ICP




Bicarb for raised ICP
This is a really interesting paper, suggesting a good alternative to hypertonic saline that avoids the problems of hyperchloraemmic metabolic acidosis:
Background 

Hypertonic saline is routinely used to treat rises in intracranial pressure (ICP) post-traumatic head injury. Repeated doses often cause a hyperchloremic metabolic acidosis. We investigated the efficacy of 8.4% sodium bicarbonate as an alternative method of lowering ICP without generating a metabolic acidosis.
Methods 
We prospectively studied 10 episodes of unprovoked ICP rise in 7 patients treated with 85 ml of 8.4% sodium bicarbonate in place of our usual 100 ml 5% saline. We measured ICP and mean arterial pressure continuously for 6 h after infusion. Serum pH, pCO2, [Na+], and [Cl−] were measured at baseline, 30 min, 60 min and then hourly for 6 h.
Results 
At the completion of the infusion (t = 30 min), the mean ICP fell from 28.5 mmHg (±2.62) to 10.33 mmHg (±1.89),P < 0.01. Mean ICP remained below 20 mmHg at all time points for 6 h. Mean arterial pressure was unchanged leading to an increased cerebral perfusion pressure at all time points for 6 h post-infusion. pH was elevated from 7.45 ± 0.05 at baseline to 7.50 ± 0.05, P < 0.01 at t = 30 min, and remained elevated. Serum [Na+] increased from 145.4 ± 6.02 to 147.1 ± 6.3 mmol/l, P < 0.01 at t = 30 min. pCO2 did not change.
Conclusions A single dose of 8.4% sodium bicarbonate is effective at treating rises in ICP for at least 6 h. Serum sodium was raised but without generation of a hyperchloremic metabolic acidosis

NEUROCRITICAL CARE
Volume 13, Number 1, 24-28, DOI: 10.1007/s12028-010-9368-8
Sodium Bicarbonate Lowers Intracranial Pressure After Traumatic Brain Injury Chris Bourdeaux and Jules Brown
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