EPISODE 31: The Beef with Bicarb! The Use of Sodium Bicarbonate in Hyperkalemia with Jimmy Pruitt

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Introduction

  1. Sodium bicarbonate was previously recommended for hyperkalemia treatment and was once considered a first-line agent for the transcellular shift.
  2. Studies evaluating the beneficial effects of sodium bicarbonate used an isotonic infusion commonly  ~ 150 mEq/ 1000ml
  3. Hypertonic sodium bicarbonate or “amp of bicarb” has an osmolality of 2000 mOsm, about 7x higher than plasma.
  4. There’s controversy as to whether hypertonic sodium bicarbonate is beneficial for the acute treatment of hyperkalemia due to modifications in the mechanism of action.

Sodium Bicarbonate in Hyperkalemia Pharmacy Friday Pearl

Sodium-Bicarbonate-for-Hyperkalemia.-pharmacy-friday-Handout.jlp1_.3

Aronson PS, Giebisch G. Effects of pH on potassium: new explanations for old observations. J Am Soc Nephrol.
Parham WA, Mehdirad AA, Biermann KM, Fredman CS. Hyperkalemia revisited. Tex Heart Inst J. 2006;33(1):40-7. PMID: 16572868; PMCID: PMC1413606.

Image
Robert T, Joseph A, Mesnard L. Calcium salt during hyperkalemia. Kidney Int. 2016 Aug;90(2):451-452. doi: 10.1016/j.kint.2016.05.016. PMID: 27418095.
Robert T, Burbach M, Joseph A, Mesnard L. Sodium is the secret re-agent of bicarbonate therapy during hyperkalemia. Kidney Int. 2016 Aug;90(2):450-451. doi: 10.1016/j.kint.2016.05.015. PMID: 27418094.
Robert T, Burbach M, Joseph A, Mesnard L. Sodium is the secret re-agent of bicarbonate therapy during hyperkalemia. Kidney Int. 2016 Aug;90(2):450-451. doi: 10.1016/j.kint.2016.05.015. PMID: 27418094.

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Refereneces

Aronson PS, Giebisch G. Effects of pH on potassium: new explanations for old observations. J Am Soc Nephrol. 2011;22(11):1981-1989. doi:10.1681/ASN.2011040414

Shingarev R, Allon M. A physiologic-based approach to the treatment of acute hyperkalemia. Am J Kidney Dis. 2010;56(3):578-584. doi:10.1053/j.ajkd.2010.03.014

  • Sodium Bicarbonate. Micromedex [Electronic version].Greenwood Village, CO: Truven Health Analytics. Retrieved August 29, 2019, 2018, from http://www.micromedexsolutions.com/
  • Gutierrez R et al. Miner Electrolyte Metab. 1991;17(5):297-302. [PMID: 1668124]
  • Fraley DSet al. Kidney Int. 1977 Nov;12(5):354-60. [PMID: 24132]
  • Blumberg A et al. Am J Med. 1988 Oct;85(4):507-12. [PMID: 3052050]
  • Blumberg A et al. Kidney Int. 1992 Feb;41(2):369-74. [PMID: 1552710 ]
  • Kim et al. Nephron. 1996;72(3):476-82. [PMID: 8852501]
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  • Long B et al. J Emerg Med. 2018 Aug;55(2):192-205. [PMID: 29731287]

ABOUT AUTHOR

Jimmy L. Pruitt III, PharmD, BCPS, BCCCP

The Pharm So Hard Podcast is a show focused primarily on emergency medicine and hospital pharmacy related topics. To empower healthcare providers with the knowledge and skills they need to provide evidence-based, safe care for critically ill patients.

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