Document Detail

Sodium bicarbonate lowers intracranial pressure after traumatic brain injury.
MedLine Citation:
PMID:  20422466     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Hypertonic saline is routinely used to treat rises in intracranial pressure (ICP) post-traumatic head injury. Repeated doses often cause a hyperchloremic metabolic acidosis. We investigated the efficacy of 8.4% sodium bicarbonate as an alternative method of lowering ICP without generating a metabolic acidosis. METHODS: We prospectively studied 10 episodes of unprovoked ICP rise in 7 patients treated with 85 ml of 8.4% sodium bicarbonate in place of our usual 100 ml 5% saline. We measured ICP and mean arterial pressure continuously for 6 h after infusion. Serum pH, pCO(2), [Na(+)], and [Cl(-)] were measured at baseline, 30 min, 60 min and then hourly for 6 h. RESULTS: At the completion of the infusion (t = 30 min), the mean ICP fell from 28.5 mmHg (+/-2.62) to 10.33 mmHg (+/-1.89), P < 0.01. Mean ICP remained below 20 mmHg at all time points for 6 h. Mean arterial pressure was unchanged leading to an increased cerebral perfusion pressure at all time points for 6 h post-infusion. pH was elevated from 7.45 +/- 0.05 at baseline to 7.50 +/- 0.05, P < 0.01 at t = 30 min, and remained elevated. Serum [Na(+)] increased from 145.4 +/- 6.02 to 147.1 +/- 6.3 mmol/l, P < 0.01 at t = 30 min. pCO(2) did not change. CONCLUSIONS: A single dose of 8.4% sodium bicarbonate is effective at treating rises in ICP for at least 6 h. Serum sodium was raised but without generation of a hyperchloremic metabolic acidosis.
Chris Bourdeaux; Jules Brown
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurocritical care     Volume:  13     ISSN:  1556-0961     ISO Abbreviation:  Neurocrit Care     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2010-10-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  24-8     Citation Subset:  IM    
Department of Anaesthesia, Frenchay Hospital, Frenchay, Bristol, BS16 1LE, UK.
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MeSH Terms
Blood Pressure / drug effects
Brain Injuries / blood,  drug therapy*,  physiopathology*
Catheterization, Central Venous
Cerebrovascular Circulation / drug effects
Chlorides / blood
Hydrogen-Ion Concentration / drug effects
Intracranial Pressure / drug effects*
Prospective Studies
Sodium / blood
Sodium Bicarbonate / administration & dosage*
Time Factors
Reg. No./Substance:
0/Chlorides; 144-55-8/Sodium Bicarbonate; 7440-23-5/Sodium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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