Bicarbonato de sodio intravenoso ¿Cuándo, cómo y por qué utilizarlo?

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dc.catalogadorgjm
dc.contributor.authorSepúlveda Palamara, Rodrigo Andrés
dc.contributor.authorJuanet Lecaros, Cristián Ignacio
dc.contributor.authorSharp Segovia, Joaquín Andrés
dc.contributor.authorKattan Tala, Eduardo José
dc.date.accessioned2023-08-16T16:25:05Z
dc.date.available2023-08-16T16:25:05Z
dc.date.issued2022
dc.description.abstractSevere metabolic acidosis is defined by a pH < 7.2 with HCO3− < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. Intravenous NaHCO3 buffers severe acidemia, preventing the associated damage and gains time while the causal disease is corrected. Its indication requires a risk-benefit assessment, considering its complications. These are hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis. For this reason, therapy must be “adapted” and administered judiciously. The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium. Isotonic solutions should be preferred instead of hypertonic bicarbonate. The development of hypernatremia must be prevented, calcium must be provided for hypocalcemia to improve cardiovascular function. Furthermore, in mechanically ventilated patients, a respiratory response similar to the one that would develop physiologically, must be established to be able to extract excess CO2 and thus avoid intracellular acidosis. It is possible to estimate the bicarbonate deficit, speed, and volume of its infusion. However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.
dc.fechaingreso.objetodigital2023-08-16
dc.fuente.origenORCID
dc.identifier.doi10.4067/s0034-98872022000901214
dc.identifier.issn0034-9887
dc.identifier.scieloidS0034-98872022000901214
dc.identifier.urihttp://dx.doi.org/10.4067/s0034-98872022000901214
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/74403
dc.information.autorucEscuela de Medicina; Sepúlveda Palamara, Rodrigo Andrés; 0000-0002-9618-3686; 252768
dc.information.autorucEscuela de Medicina; Juanet Lecaros, Cristián Ignacio; S/I; 1052451
dc.information.autorucEscuela de Medicina; Sharp Segovia, Joaquín Andrés; S/I; 215655
dc.information.autorucEscuela de Medicina; Kattan Tala, Eduardo José; 0000-0002-1997-6893; 172152
dc.issue.numero9
dc.language.isoes
dc.nota.accesoContenido completo
dc.pagina.final1223
dc.pagina.inicio1214
dc.revistaRevista médica de Chile
dc.rightsacceso abierto
dc.subjectAcidosis
dc.subjectBicarbonates
dc.subjectHypernatremia
dc.subjectHypocalcemia
dc.subjectSodium bicarbonate
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleBicarbonato de sodio intravenoso ¿Cuándo, cómo y por qué utilizarlo?
dc.title.alternativeIntravenous sodium bicarbonate. When, how and why to use it?
dc.typeartículo
dc.volumen150
sipa.codpersvinculados252768
sipa.codpersvinculados1052451
sipa.codpersvinculados215655
sipa.codpersvinculados172152
sipa.indexScielo
sipa.trazabilidadORCID;2023-08-16
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