bicarbonate in paediatric ALS
Last reviewed 01/2018
Sodium bicarbonate is often used in the resuscitation of children, with the aim of reducing the acidosis presumed to occur during an arrest.
- cardiac
arrest results in combined respiratory and metabolic acidosis, caused by cessation
of pulmonary gas exchange, and the development of anaerobic cellular metabolism
respectively
- best treatment for acidaemia in cardiac arrest is a combination
of chest compression and ventilation. Furthermore, giving bicarbonate causes generation
of carbon dioxide which diffuses rapidly into the cells. This has the following
effects:
- exacerbates intracellular acidosis
- produces a negative inotropic effect on ischaemic myocardium
- presents a large, osmotically active, sodium load to an already compromised circulation and brain
- produces a shift to the left in the oxygen dissociation curve further inhibiting release of oxygen to the tissues
- routine use of sodium bicarbonate
in cardiac arrest is not recommended.
- may be considered in prolonged arrest, and it has a specific role in hyperkalaemia and the arrhythmias associated with tricyclic antidepressant overdose. The dose is 1-2 ml per kg of the 8.4% solution given by the IV or IO routes
- best treatment for acidaemia in cardiac arrest is a combination
of chest compression and ventilation. Furthermore, giving bicarbonate causes generation
of carbon dioxide which diffuses rapidly into the cells. This has the following
effects:
Reference:
- Resuscitation Council (UK). Advanced Paediatric Life Support. Guidelines 2005.