Getting Salty (With Bicarbonate)

Yep, it works.

One of the so-called “tricks of the trade” percolating over the past decade has been to move past the 3% saline solution in severe hyponatremia and grab the handy, crash-cart 8.4% sodium bicarbonate ampule instead. After all, 50mL of 8.4% NaHCO3 is 50.0 mEq, similar to the 51.3 mEq in 100mL of 3% NaCl.

The guidelines state the goal of treatment should be to raise serum sodium by >4-6 mEq with treatment – and, this little retrospective study observed it did a fine job at that:

And, no central access needed! (that’s probably also another enduring piece of dogmatic avoidance, as well)

The nature of their retrospective analysis precludes any patient-oriented outcomes being measured, and there’s no basis upon which to claim superiority of the bicarbonate solution – but it’s a little piece of reassuring data to reinforce ongoing uptake of this practice.