PaEasy Emergency Medicine Practice Exam

Which criterion indicates the use of sodium bicarbonate therapy in metabolic acidosis?

Fluids and oxygen only Sodium bicarbonate therapy Oxygen only No intervention unless shock

Correct Answer:

Sodium bicarbonate therapy

Explanation:

In metabolic acidosis, the decision to use sodium bicarbonate hinges on the severity of the acidemia and the bicarbonate deficit. The best criterion for giving bicarbonate is the presence of significant acidemia, typically a pH around 7.1 or lower, with a very low bicarbonate level (about 8 mEq/L or less). At this level, raising the pH with bicarbonate can improve cardiac function and prevent hemodynamic collapse. Giving bicarbonate is not routinely done for mild acidosis, because it can cause volume overload, sodium overload, and increased CO2 generation, which may worsen intracellular acidosis. In certain toxin-induced or high-anion-gap cases, bicarbonate can be particularly helpful, but the key factor remains the severe acidemia and depleted bicarbonate.

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