IV Bicarb: Is There Any Value?

IV Bicarbonate used to be all the rage in critical care. It was included in the ACLS algorithms. It was used, in drips or in pushes, to treat all kinds of problems. I’ll admit, there are still times that I use it when the indication is…shaky, often when my back is against the wall and I need something to buy some time. But, is there any real use for it in ICU practice? In a recent episode of The Elective Rotation, Pharmacy Joe recently took a look at when IV bicarb should be avoided (often) and when it is helpful (a lot less often).

Often, IV bicarb is used as a band-aid. This is ok to a point. If it helps buy you some time, ok. But using it without addressing the underlying issues (like I remember doing a lot in the old days) is fraught with problems. There are a handful of scenarios where we should avoid using bicarb because it’s been shown to be of no value. ACLS has removed it from the algorithms and generally avoids against its use in cardiac arrest, for example. But there are some specific times when it is helpful and should be considered.

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