- Joined
- Nov 6, 2003
- Messages
- 989
- Reaction score
- 261
Howdy all -
Have a question for the smarter ones than me on here regarding acidosis & bicarb...
In the setting of metabolic acidosis (severe sepsis, salicylates, etc) with pH ~7 or lower, I know typically a bicarb drip gets started (especially for salicylate poisoning)... however, when these patients need to be intubated, there's a few potential problems:
1) we can't possibly replace their own respiratory rate/compensation
2) sometimes they get paralyzed, and at least get sedated
The net result of these is a potential increase in respiratory acidosis during the peri-intubation period (yea, several case reports discuss the complications of intubating a salicylate-poisoned patient). As such, I've begun recommending pushing 1-2 amps of NaHCO3 immediately before intubation, as an adjunct to RSI.
However, I only do this based on my understanding of the underlying pathophys & acid/base, as well as the pharmacokinetics of ASA (and subsequently derive it over into any significant metabolic acidosis that needs to be intubated). I can't find a good reference in the literature to back this up otherwise.
Anyone out there have any useful citations regarding this?
Appreciate the input...
-t
Have a question for the smarter ones than me on here regarding acidosis & bicarb...
In the setting of metabolic acidosis (severe sepsis, salicylates, etc) with pH ~7 or lower, I know typically a bicarb drip gets started (especially for salicylate poisoning)... however, when these patients need to be intubated, there's a few potential problems:
1) we can't possibly replace their own respiratory rate/compensation
2) sometimes they get paralyzed, and at least get sedated
The net result of these is a potential increase in respiratory acidosis during the peri-intubation period (yea, several case reports discuss the complications of intubating a salicylate-poisoned patient). As such, I've begun recommending pushing 1-2 amps of NaHCO3 immediately before intubation, as an adjunct to RSI.
However, I only do this based on my understanding of the underlying pathophys & acid/base, as well as the pharmacokinetics of ASA (and subsequently derive it over into any significant metabolic acidosis that needs to be intubated). I can't find a good reference in the literature to back this up otherwise.
Anyone out there have any useful citations regarding this?
Appreciate the input...
-t