SODIUM BICARBONATE IN CARDIAC ARREST- NOT WITHOUT HAZARDS

Sodiu!ll bicarbonate is commonly used to correct base deficit associated with the metabolic acidosis of cardiac arrest, but its use is not without hazards.

• In this age of the indwelling intravenous catheter, it is tempting to give sodium bicarbonate too often and too early. • During prolonged cardiac arrest and resuscitation, a hyperosmolal condition arises which is accentuated by sodium

bicarbonate. • Bicarbonate generates carbon dioxide which diffuses into the cerebrospinal fluid causing a paradoxicalacidosis and

into the myocardium resulting in a worsening of intracellular acidosis and myocardial depression. • An 8.4% sodium bicarbonate solution is unphysiological and hyperosmolal. In excess, it is·clearly harmfuL The

SOOml packs of this solution should not be used - in the excitement of a cardiac arrest, too much may be infused. Smaller volumes or less hyperosmolal solutions are preferable.

Editorial: Lancet 1: 946 (1 May 197 6)

INPHARMA8th May, 1976p3