ALS Pearls for MCEM B Part 2

Use of Sodabicarbonate in Cardiac Arrest

Indications: Alkalinization to correct pH if cardio-respiratory arrest due to HYPERKALEMIA (K+ more than 5.5), TCA overdose, or prolonged arrest state

Dose: 50 ml of 8.4% solution (50 mmol)

It is not recommended to use it routinely:

1.  Exacerbates intracellular acidosis:

            a) Generates CO2 which diffuses rapidly into cells (respiratory acidosis)

b) Stimulates phosphofructokinase in glysolysis to generate more pyruvate, thereby increased lactate formation (lactic acidosis)

2. Shifts O2-Hb curve to left, thereby causing decreased release of O2

3. Negative ionotropic effect on ischemic myocardium

4. Large osmotically active Na load, causing cellular swelling