Base deficit and the use of bicarbonate/buffer.

[Stefan Johansson]

I visited Hot Topics last year and one of the best lectures (according to me!) was held by Judy Aschner, about the use of sodium bicarbonate being principally useless (and could even have adverse effects).

Please click here to read an excellent review article on the topic by Aschner and Poland.

Unfortunately only the abstact is available for free, but the article is worth to order!

As many other units, we have a strong tradition to consider the use buffer, if pH is less than 7.25 and BE less than -5 (at least in in ELBW infants)

The article by Aschner and Poland has been subjected to some debate in our units. The major argument in favour of buffer is that we do not use sodium bicarbonate but Tribonat, which is a combination of trometamol (THAM), bicarbonate och acetate. The theoretical idea behind Tribonat is to achieve intracellular (THAM), extracellular (bicarb & acetate).

Personally, I have switched to a quite restrictive approach and rarely use buffer, but try to consider the etiology of the base deficit in the management of acid-base.

What's your experience and view upon the use of buffer?!

[hehady]

Dear Stefan

It is true most of us are now more and more restrictive on using NaHCo3. I think the next version of NRP will also decrease their role in resuscitation.

Personally in our unit we started a restrictive policy about 1 year ago, I do agree the treatment of acidosis should be directed to the cause rather than giving NaHCO3.

We do not have tribonat or THAM in our country and I do not have experience in there use.

Thanks for this hint from hot topics, would you also elaborate more on therapeutic hypothermia in HIE (hot topics 2008 had a session on this issue)

[Guest maedmu]

Dear,

We use sodium bicarbonate , when ph is below 7.2 , or bicarbonate below 12, but in any cases we use to prevent acidosis, We use in infusion around of four to six hours the question is its allright???, there are many studies that discourages the use of bicarbonate but we still use .... ,

Its an interesting topic

We dont have buffer in our country.

Thanks foir your commentaries

Manuel Munaico

[Stefan Johansson]

This topic is worth to be bumped.

And I added a poll too!

[Dr. Saad Ahmed Seth]

Dear All,

I am new to this forum.

In our unit it was frequently used on almost every baby 3-4 years back.

But recently the trend has changed and it is rarely used.

I prefer using it in sick VLBW babies, with PH below 7.2, and BD of more than -10.

Regards

[takshafat]

personally i also feel that treatment should be directed at the cause,however in our unit it is still sometimes used,when ph is <7.2 or bicarb is <10

[Padkaer]

Dear All,

I´m am new to this forum. In my unit we very rarely use NaHCO3.

In the extremely premature mechanicaly ventilated child with an BE below -10 and a pH below 7,25 NaCHO3 is sometimes uses for a short time.

[sSnjezana]

Dear All,

We use NaHCO3 when we have "unvigorously" baby (Apgar score first min <3) and if he/she have not recovered by ventilation. Also, we use bicarbonate if the baby has significant metabolic acidosis + resp. acidosis and if he/she doesn't recover with changing parameters of ventilation. When is pH < 7,1 and BE> 10-11 , without resp. acidosis we use NaHCO3 during 30min (half of doses).

I read that article, it is fantastic.

And the question: what does happend with intracellular acidosis when we use bicarbonate in metabolic "blood" acidosis?

Another one: what with use of Ca in infusion in that babies, because in hypoxia and asphyxia Ca acts very important role? Hypocalcaemia is the sign of Ca level in blood, what is with Ca level in cells?

[Guest lorenasoler]

so, what is more detrimental? the acidosis with less than 7.10 (pick a number) or the bicarbonate?

[Stefan Johansson]

so, what is more detrimental? the acidosis with less than 7.10 (pick a number) or the bicarbonate?

Check this out:

http://pediatrics.aappublications.org/cgi/content/abstract/122/4/831

The issue raised by the authors is rather that bicarbonate is useless.

Even, the authors write:

Indeed, there is evidence that this therapy is detrimental.