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.

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Is hypertonic sodium bicarbonate used to treat hyperkalemia frequently in your institution ?

— The Pharm So Hard Podcast (@pharmso_hard) February 17, 2021

Sodium Bicarbonate in Hyperkalemia Pharmacy Friday Pearl

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How does calcium "stabilize the cardiac membrane" in hyperkalemia?

I learned early in my intern year to use calcium in the setting of severe hyperkalemia.

I never really learned how it works. The answer requires some history. And uncovers a forgotten alternative treatment. pic.twitter.com/FENJMsUxUh

— Tony Breu (@tony_breu) November 28, 2020

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/
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• Long B et al. J Emerg Med. 2018 Aug;55(2):192-205. [PMID: 29731287]

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