During a recent shift, our emergency department (ED) team saw a patient with fairly severe diabetic ketoacidosis. The patient's serum bicarbonate level was 6 mEq/L and the venous pH was 6.85. During discussions with the admitting intensive care team, we debated whether to give intravenous sodium bicarbonate. We chose to withhold it, although the intensive care team initiated a bicarbonate infusion soon after they assumed care. The patient eventually recovered, but it remained uncertain whether the sodium bicarbonate made any difference.
Later during that same shift, a patient arrived in cardiac arrest. It was a 65-year-old man with known coronary artery disease who suffered an unwitnessed arrest with unknown downtime. The initial rhythm when paramedics arrived was asystole, but after three rounds of standard advanced cardiac life support (ACLS) drugs, the patient had pulseless electrical activity with a narrow QRS rhythm at a rate of 60/min. Standard ACLS measures were continued, during which, once again, we debated whether to use sodium bicarbonate for the "prolonged downtime" and suspected acidosis. We gave two doses of sodium bicarbonate, but the patient eventually went into asystole again and was pronounced dead after an hour.
Sodium Bicarbonate Use in the ED
What is the role of sodium bicarbonate in the ED?
