The Pearls of Acid Base balance...Bicarb Therapy

First don't give Bicarb based on PH
Give Bicarb based on HCO3 level,if HCO3 <5

If HCO3 < 5 ,give 1 or two vials..enough and reasses the ABGs

If you found the PCO2 > 1.5 (HCO3) + 8,then ventilate the patient ,don't give HCO3

As U notice there are a lot of Don'ts ....yes don't use BICARB liberally ,Bicarb has its own risks:

Risk One:

Bicarb when adminstered it will release the CO2 Molecules that it holds -(HCO3...did use ce the CO2)-into the circulation ,which diffuse intracelluraly causing significant intracellular acidosis.

Risk two:

Bicarb ,it is Sodium bicarb...yes there is sodium,the questio is How much sodium?

1L of 0.9% NSS contains 154 Meq of Sodium
1L of NaBicarb,contains 1000 Meq of sodium,thus the the 50 cc ampule contains 50 Meq..which is 1/3 the amount of sodium in 1L of NSS....
This huge amount of Sodium may cause uninetntional increase in sodium levels causing hypernatremia and then fluid overload...
This High sodium content could be benificial in cases of brain edema and can be used as hyperosmolar therapy,imagine.

Risk three:
excessive use of Bicarb causes HYPOKALEMIA....

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