Recently I gave a lecture at Arrowhead EMS Conference on when to treat metabolic acidosis with sodium bicarbonate. I attempted to record the lecture live and had some AV difficulties that prevented me from being able to. Soooo I re-did an abbreviated version of this talk into a screen-cast.
I think we can all agree that there is never a reason to treat a respiratory acidosis with sodium bicarbonate. So we really are asking:
When do we treat a metabolic acidosis with sodium bicarb?
There really are two reasons to give sodium bicarb. Either your soda machine is completely out of order (renal failure) or you are losing soda(bicarb) faster than the machine can make it (diarrhea). I think of it like a soda machine with the soda being bicarbonate, which kinda makes sense because of the carbonation.
So let's talk about some cases, how to give it, and when its acceptable to just push it as opposed to a drip.
DKA- anion gap acidosis
Lactic Acidosis - anion gap acidosis
Loss of Bicarb - NAGMA (Non-anion gap acidosis)
All included in this podcast!