Bicarb drip
Formal Definition
An intravenous infusion of sodium bicarbonate solution, used therapeutically for severe metabolic acidosis, hyperkalemia with EKG changes, certain intoxications (aspirin, tricyclic antidepressants), urine alkalinization, or renal tubular acidosis management.
How It's Used on the Ward
"Bicarb drip" or "running bicarb" — used in critical care situations where rapidly correcting pH or shifting potassium intracellularly is needed.
Example
""pH 6.98, bicarb 7, K 6.8 with peaked T-waves — started a bicarb drip and calcium gluconate while the nephrology fellow was getting there for emergent dialysis. EKG normalized within 20 minutes.""
Clinical Context
Bicarb administration is temporizing in severe metabolic acidosis — it shifts pH but does not fix the underlying cause. In DKA, bicarb is generally not given unless pH <6.9 (can worsen hypokalemia and paradoxically increase CNS acidosis). In hyperkalemia, bicarb shifts K+ into cells within 30–60 minutes. Be aware: sodium bicarbonate contains significant sodium (hypernatremia risk in large doses) and can worsen fluid overload.
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