Hello, what is the general consensus of the use of bicarbonate in your NICU's.

Do you use it often? Continuos infusion? Bolus?

Thank you!

Greetings from Mexico City

Sion.

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We hardly use it anymore. There seems to be no evidence that administration of bicarbonate improves outcome. In fact, it can be detrimental. Wat does improve outcome is adequate treatment of the underlying cause of acidemia.

http://pediatrics.aappublications.org/content/122/4/831.long

Best regards

Christ-jan van Ganzewinkel

Neonatal Nurse Practitioner

NICU

Máxima Medical Centre, Veldhoven

The Netherlands

A Term baby, out-born with perinatal asphyxia was referred to our unit at 2hrs of life.

Initial examination findings

HR 136/min; RR: 88/min; NIBPmean: 36mmHg; SPo2:94% with 2L/min O2 through head box, CFT=2sec, warm

Initial blood gases revealed metabolic acidosis with pH of 7.167, PCO2-34.9;HCO3-13.6 and BE of -16.

Should i correct the metabolic acidosis with sodium bicarbonate?

Edited November 17, 201212 yr by sageaugie

Initial blood gases revealed metabolic acidosis with pH of 7.167, PCO2-34.9;HCO3-13.6 and BE of -16.

Should i correct the metabolic acidosis with sodium bicarbonate?

I'd would say, wait and see/re-check the blood gas.

No, your bloodgas will Look better, but no effect on outcome, in fact Babys cardiac function might be impaired.

I am in favour of giving NS bolus 10ml/kg over 30 minute ,ask for functional echocardiography and cardiac support if required .Repeat ABG after a hour or two.W/F cardic function and renal function if normal.this might help to correct metabolic acidosis.rRespiratory function looks to be good.

Dinesh

we use boluses, very few pts once recieving bicarb ever have a chance ,most dont improve esp critical patients, though we had to use it in a few with renal failure when the results were bettter clinically,

Earlier, we often used bicarbonate infusion for correction of metabolic acidosis. Sometimes we use prolonged infusion with low speed of infusion.

The effect of iv bicarbonate is very doubtful. You may see improvements in your analysis but as often without any improvements in clinic

You can wait or you can gine one bolus dodse normal saline 10 ml/kg & then rpt gases after one hour

hi ...

in our NICU ... WE JUST use it when PH is less than 7.0 and just 1/3 or 1/2 correction .. but for your reading .. i would like to give N/S 10 cc/kg and repeat ABG after 1hr

This base deficit not possible to correct physiologically . I think you should correct by Bolus bicarbonate initially then continuous infusion and check ABG again . Before correction ensure perfusion

It's not purely metabolic acidosis here there is also respiratory acidosis . Please check for mechanical ventilator support and also correct bicarbonate deficit and maintain adequate perfusion

Dr Kamrul Hassan Shabuj

Dhaka Bangladrsh

i give Ns 1st and do ABG after ,if still i give bicarbonate 1/2 correction