Sodium bicarbonate in the perinatal setting--revisited.

After more than 25 years of experience with sodium bicarbonate, the following conclusions may be in order: 1. It is not certain that the net effect of administration of this agent to patients with metabolic acidosis is positive, other than when given as replacement for renal or gastrointestinal bicarbonate losses. 2. Adequate oxygenation and ventilation must be ensured before it is given. 3. Profound fluctuations in blood pressure and cerebral blood flow, intracranial bleeds, and compromise of oxygen delivery to tissues all have been found to be possible adverse effects of sodium bicarbonate infusion. Because hyperosmolarity and sodium content are important factors, the commercially prepared solutions (0.9 or 1M) should be diluted 1:2 to 1:4 with water and given over not less than several minutes--if it is to be given at all. 4. Current recommendations for dose, dilution, and rate of administration, including those mentioned above, are largely arbitrary. If sodium bicarbonate were a newly proposed treatment for hypoxic metabolic acidosis, one would recommend that carefully conducted prospective laboratory and clinical trials be done before giving it to sick patients. As it is in widespread use, one can only reiterate that if it is to be given, it should be used with extreme caution.