Skip to main content
SpringerLink
Log in

Hemodynamic effects of sodium bicarbonate in critically ill neonates

  • Neonatal and Pediatric Intensive Care
  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis.

Design

Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration.

Setting

Neonatal intensive care unit, tertiary care center.

Patients

Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH<7.25 in premature and <7.30 in term infants, base deficit>−8).

Intervention

An 8.4% sodium bicarbonate solution diluted 1∶1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula “base deficit x body weight (kg)×1/3×1/2”.

Measurements and results

Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (−39.3%). Calculated systemic vascular resistance (SVR) (−10.7%) and diastolic BP (−11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline.

Conclusion

Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Iberti TJ, Kelly KM, Gentili DR, Rosen M, Katz DP, Premus G, Benjamin M (1988) Effects of sodium bicarbonate in canine hemorrhagic shock. Crit Care Med 16:779–782

    Google Scholar 

  2. Bersin RM, Chatterjee K, Arieff AI (1989) Metabolic and hemodynamic consequences of sodium bicarbonate administration in patients with heart disease. Am J Med 87:7–14

    Google Scholar 

  3. Mäkisalo HJ, Soini HO, Nordin AJ, Hoeckerstedt KAV (1989) Effects of bicarbonate therapy on tissue oxygenation during resuscitation of hemorrhagic shock. Crit Care Med 17:1170–1174

    Google Scholar 

  4. Huseby JS, Gumprecht DG (1985) Hemodynamic effects of rapid bolus hypertonic sodium bicarbonate. Chest 79:552–554

    Google Scholar 

  5. Graf H, Leach W, Arieff AI (1985) Evidence for detrimental effect of bicarbonate therapy in hypoxic lactic acidosis. Science 227:754–756

    Google Scholar 

  6. Cooper DJ, Wothley LIG (1987) Adverse haemodynamic effects of sodium bicarbonate in metabolic acidosis. Intensive Care Med 13:425–427

    Google Scholar 

  7. Bureau MA, Begin R, Berthiaume Y, Shapcott D, Khoury K, Gagnon N (1980) Cerebral hypoxia from bicarbonate infusion in diabetic acidosis. J Pediatr 96:968–973

    Google Scholar 

  8. Finberg L (1967) Dangers to infants caused by changes in osmolal concentration. Pediatrics 40:1031–1037

    Google Scholar 

  9. Rhodes PG, Hall RT, Hellerstein S (1977) The effects of single infusions of hypertonic sodium bicarbonate on body composition in neonates with acidosis. J Pediatr 90:789–795

    Google Scholar 

  10. Finberg J (1977) The relationship of intravenous infusions and intracranial hemorrhage—a commentary. J Pediatr 91:777–778

    Google Scholar 

  11. Papile LA, Burstein J, Burstein R, Koffler H, Koops B (1978) Relationship of intravenous sodium bicarbonate infusions and cerebral intraventricular hemorrhage. J Pediatr 93:834–836

    Google Scholar 

  12. Sessler D, Mills P, Gregory G, Litt L, James T (1987) Effects of bicarbonate on arterial and brain intracellular pH in neonatal rabbits recovering from hypoxic lactic acidosis. J Pediatr 111:817–823

    Google Scholar 

  13. Wheeler AS, Sadri S, Gutsche BB, Devore JS, David-Mian Z, Latisevsky H (1979) Intracranial hemorrhage following intravenous administration of sodium bicarbonate or saline solution in the newborn lamb asphyxiated in utero. Anaesthesiology 51:517–521

    Google Scholar 

  14. Savignoni PG, Bucci G, Ceccamea A, Mendicini M, Scalamandre A, Orzalesi MM (1969) Intravenous infusion of glucose and sodium bicarbonate in hyaline membrane disease. Acta Paediatr Scand 58:1–9

    Google Scholar 

  15. Kravath RE, Aharon AS, Abal G, Finberg L (1970) Clinically significant physiologic changes from rapidly administered hypertonic solutions: acute osmol poisoning. Pediatrics 46:267–275

    Google Scholar 

  16. Russel G, Cotton EK (1968) Effects of sodium bicarbonate by rapid injection and of oxygen in high concentration in respiratory distress syndrome of the newborn. Pediatrics 141:1063–1073

    Google Scholar 

  17. Alverson DC, Eldrigde M, Dillon T (1982) Noninvasive pulsed Doppler determination of cardiac output in neonates and children. J Pediatr 101:46–50

    Google Scholar 

  18. Sjöberg BJ, Wranne B (1990) Cardiac output determined by ultrasound-Doppler — clinical applications. Clin Physiol 10:463–473

    Google Scholar 

  19. Nicolosi GL, Pungercic E, Cervesato E (1988) Feasibility and variability of six methods for the echocardiographic and Doppler determination of cardiac output. Br Heart J 59:299–303

    Google Scholar 

  20. Notterman DA, Castello FV, Steinberg C (1989) A comparison of thermodilution and pulsed Doppler cardiac output measurement in critically ill children. J Pediatr 115:554–560

    Google Scholar 

  21. Hudson I, Houston A, Aitchison T (1990) Reproducibility of measurements of cardiac output in newborn infants by Doppler ultrasound. Arch Dis Child 65:15–19

    Google Scholar 

  22. Shapiro JI, Whalen M, Kucera R, Kindig N, Filley G, Chan L (1989) Brain pH responses to bicarbonate and cabicarb during systemic acidosis. Heart Circ Physiol 25:H1316-H1321

    Google Scholar 

  23. Simmons MA, Adcock EW, Bard H, Battaglia F (1974) Hypernatremia and intracranial hemorrhage in neonates. N Engl J Med 291:6–10

    Google Scholar 

  24. Perlman JM, Goodman S, Kreusser KL, Volpe JJ (1985) Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood-flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med 312:1353–1357

    Google Scholar 

  25. Lou HC, Lassen NA, Friis-Hansen B (1979) Impaired autoregulation of cerebral blood flow in the distressed newborn infant. J Pediatr 94:118–121

    Google Scholar 

  26. Weil HM, Rackow EC, Trevino R, Grundler W, Falk JL, Griffel MI (1986) Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med 315:153–156

    Google Scholar 

  27. Adrogué HJ, Rashad MN, Gorin AB, Yacoub J, Madias NE (1989) Assessing acid-base status in circulatory failure: differences between arterial and central venous blood. N Engl J Med 320:1312–1316

    Google Scholar 

  28. Bishop RL, Weisfeldt ML (1976) Sodium bicarbonate administration during cardiac arrest. JAMA 235:506–509

    Google Scholar 

  29. Steichen JJ, Kleinman LI (1977) Studies in acid-base balance. I. Effect of alkali therapy in newborn dogs with mechanically fixed ventilation. J Pediatr 91:287–291

    Google Scholar 

  30. Tremper KK, Shoemaker WC (1981) Transcutaneous oxygen monitoring of critically ill adults, with and without low flow shock. Crit Care Med 10:706–709

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Intensive Care Unit, University Children's Hospital, Steinwiesstraße 75, CH-8032, Zürich, Switzerland

    S. Fanconi MD, R. Burger, D. Ghelfi & J. Uehlinger

  2. Department of Cardiology, University Children's Hospital, Steinwiesstraße 75, CH-8032, Zürich, Switzerland

    U. Arbenz

Authors
  1. S. Fanconi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Burger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Ghelfi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Uehlinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. U. Arbenz
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fanconi, S., Burger, R., Ghelfi, D. et al. Hemodynamic effects of sodium bicarbonate in critically ill neonates. Intensive Care Med 19, 65–69 (1993). https://doi.org/10.1007/BF01708362

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01708362

Key words

Search

Navigation