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    Feb 2010

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    Default Bases Other Than Bicarb

    This has always made me wonder, and I've never been able to find an acceptable answer.

    Na bicarb is falling out of favor in codes due to the fact that it's neutralization reaction with acids is dependent on adequate ventilation and perfusion to then eliminate the CO2 produced after the neutralization reaction. This is usually a problem in a patient with crap CO from even great chest compressions, leading to increased CO2 which can potentially increase intracellular acidosis.

    So why do we only have a drug that is so dependent on the patient being alive and well in the first place to work effectively? Why not use bases that aren't dependent on ventilation, like NaOH or Ca(OH)2? I get that NaOH is super strong and causes chemical burns and releases heat during neutralization, but wouldn't this be solved by adequate dilution? This way the only products would be water, sodium and whatever anion is left over?

    I know we also have THAM available, but this is also normally used as a volume expander as well. Plus, if it were superior to bicarb I'd think it would be more well know.

    Any ideas, or I am missing something big that makes this an obvious no?
    Last edited by erc512; 03-24-2011 at 07:43 PM.
    CRNA: Rate your pain from 0-10.
    Patient: 6... If 10 is being mauled by a bear.

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