Sodium Bicarbonate

Routine administration of sodium bicarbonate is not recommended in cardiac arrest. (Class III, LOE B)

Sodium bicarbonate may be administered for treatment of some toxidromes (see “Toxicological Emergencies,” below) or special resuscitation situations such as hyperkalemic cardiac arrest.

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During cardiac arrest or severe shock, arterial blood gas analysis may not accurately reflect tissue and venous acidosis.1,2 Excessive sodium bicarbonate may impair tissue oxygen delivery;3cause hypokalemia, hypocalcemia, hypernatremia, and hyperosmolality;4,5 decrease the VF threshold;6and impair cardiac function.


  1. Weil MH, Rackow EC, Trevino R, Grundler W, Falk JL, Griffel MI. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med. 1986;315:153–156.
  2. Steedman DJ, Robertson CE. Acid-base changes in arterial and central venous blood during cardiopulmonary resuscitation. Arch Emerg Med. 1992;9:169–176.
  3. Wayne MA, Delbridge TR, Ornato JP, Swor RA, Blackwell T. Concepts and application of prehospital ventilation. Prehosp Emerg Care. 2001;5:73–78.
  4. Mattar JA, Weil MH, Shubin H, Stein L. Cardiac arrest in the critically ill. II. Hyperosmolal states following cardiac arrest. Am J Med. 1974;56:162–168.
  5. Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, Hargarten KM, Thompson B. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992;10:4–7.
  6. Bishop RL, Weisfeldt ML. Sodium bicarbonate administration during cardiac arrest. Effect on arterial pH PCO2, and osmolality. JAMA. 1976;235:506–509.
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Sodium Bicarbonate