In patients with acidosis and hyperkalemia who need fluid resuscitation, you can use isotonic bicarbonate (3 amps bicarb in D5W) as a bolus/infusion - this is a less hypertonic solution and works well when added to other interventions (insulin, beta agonist etc..). Please stop using bicarbonate pushes in these patients.
thank you so very much Corey!! I haven't see you for a while, missed you greatly. I am very disappointed tho, was wanting 2-3 hours on electrolytes. couple of thoughts: 1. when you are trying to convince your colleagues (fellow ED docs, hospitalists, and even nephrology consultants ) about one's (and my own) personal ideas regarding the potential horrors of Kayexalate, tread lightly, tactfully, almost like walking on rice paper. some folk hold this topic and their beliefs regarding Kayexalate almost like religion, politics, and such.
2. excellent review here
3. my thought on David P's comment.. I do think I recall Scott Weingart saying a poor man's (or quick way) of giving the equivalent of 100 ml of hypertonic 3% NS is three amps of Na Bicarb push., either for severe symptomatic hyponatremia, or especially say for ICH with impending herniation. but David refers to a different situation.
Give it's crapy pH, SID of zero and potential (granted need more than a liter) to cause a hyperchloremic metabolic acidosis is NS truly the preferred choice over LR?
Who remembers Dr. Slovis's 5 favorite movies? When I studied with him as a med student in late 1980's it was on the ER rotation test and was: 1. Man with 2 brains 2. Original In-laws 3. ?Blazing Saddles or Young Frankenstein (can't remember) 4. Buckaroo Banzei 5.??????????? I would have failed the test!
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Daniel P. - August 16, 2021 12:22 PM
In patients with acidosis and hyperkalemia who need fluid resuscitation, you can use isotonic bicarbonate (3 amps bicarb in D5W) as a bolus/infusion - this is a less hypertonic solution and works well when added to other interventions (insulin, beta agonist etc..). Please stop using bicarbonate pushes in these patients.
Shivam P. - August 16, 2021 4:00 PM
dope
tom f. - August 23, 2021 1:46 AM
thank you so very much Corey!! I haven't see you for a while, missed you greatly. I am very disappointed tho, was wanting 2-3 hours on electrolytes. couple of thoughts:
1. when you are trying to convince your colleagues (fellow ED docs, hospitalists, and even nephrology consultants ) about one's (and my own) personal ideas regarding the potential horrors of Kayexalate, tread lightly, tactfully, almost like walking on rice paper. some folk hold this topic and their beliefs regarding Kayexalate almost like religion, politics, and such.
2. excellent review here
3. my thought on David P's comment.. I do think I recall Scott Weingart saying a poor man's (or quick way) of giving the equivalent of 100 ml of hypertonic 3% NS is three amps of Na Bicarb push., either for severe symptomatic hyponatremia, or especially say for ICH with impending herniation. but David refers to a different situation.
thanks again, Corey.
tom fiero, merced, ca.
Sean R. - September 1, 2021 3:38 PM
Give it's crapy pH, SID of zero and potential (granted need more than a liter) to cause a hyperchloremic metabolic acidosis is NS truly the preferred choice over LR?
Mignon B. - October 28, 2021 11:45 AM
Who remembers Dr. Slovis's 5 favorite movies? When I studied with him as a med student in late 1980's it was on the ER rotation test and was:
1. Man with 2 brains
2. Original In-laws
3. ?Blazing Saddles or Young Frankenstein (can't remember)
4. Buckaroo Banzei
5.???????????
I would have failed the test!