ICU SAQs · AKI & RRT
Bicarbonate in severe metabolic acidaemia and the management of hyperkalaemia
Integrates the BICAR-ICU evidence (bicarbonate does not improve overall outcome in severe acidaemia), the stepwise emergency management of hyperkalaemia with ECG change, and the transition to renal replacement therapy. A high-yield integration SAQ.
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Prompt
A 70-year-old man with AKI and lactic acidosis from mesenteric ischaemia has a pH of 7.12, a standard bicarbonate of 8 mmol per litre and a potassium of 6.9 mmol per litre with peaked T waves on his ECG. What is the role of sodium bicarbonate in severe metabolic acidaemia, outline the emergency management of his hyperkalaemia, and state the indications for renal replacement therapy in this patient.
Question
A 70-year-old man with AKI and lactic acidosis from mesenteric ischaemia has a pH of 7.12, a standard bicarbonate of 8 mmol per litre and a potassium of 6.9 mmol per litre with peaked T waves on his ECG. What is the role of sodium bicarbonate in severe metabolic acidaemia, outline the emergency management of his hyperkalaemia, and state the indications for renal replacement therapy in this patient.
[1]References3ShowHide
- [1]Jaber S, Paugam C, Futier E, et al. Sodium Bicarbonate Therapy for Patients With Severe Metabolic Acidaemia in the Intensive Care Unit (BICAR-ICU). Lancet, 2018.PMID 29910040
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.