• Chris Bourdeaux and Jules Brown.
• Department of Anaesthesia, Frenchay Hospital, Frenchay, Bristol, BS16 1LE, UK. chrisbourdeaux@gmail.com
• Neurocrit Care. 2010 Aug 1;13(1):24-8.

BackgroundHypertonic 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.MethodsWe 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.ResultsAt 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.ConclusionsA 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.

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