While managing Patient with hyperkalemia ,we administer sodium bicarbonate !how does it work , or mechanism in action ?
Bicarbonate should only be used to treat Acute hyperkalemia in case of metabolic acidosis or else it is not effective.
Isotonic bicarbonate to expand plasma dilutes potassium concentration when given in large quantities. Hypertonic bicarbonate appears ineffective. 8.4 percent Sodium Bicarbconate should not be given as it is ineffective in most studies.
Few proposed mechanisms:
Most of the body's potassium is in skeletal muscles. Bicarbonate can shift potassium into muscle cells by lowering serum pH by causing shift of potassium into cells via an H+/K+ exchange mechanism.
0 Metabolic alkalosis facilitates potassium excretion from kidney by regulation of potassium channels in the distal nephron which are up-regulated by alkalosis.
Metabolic alkalosis inhibits proximal tubule re-absorption of sodium bicarbonate, and potassium excretion by increasing distal sodium concentration and flow rate.
Administration of sodium bicarbonate increase the concentration of Na+ in the extracellular fluid compartment. High extracellular Na+ concentration leads to its increased cellular uptake via the sodium-proton exchanger. The subsequent movement of Na+ out of the cell creates an electric gradient, forcing K+ into the cell via Na+-K+-ATPase, resulting in net increase in intracellular K+ .
It is depends of the mechanism and ethiology of hyperkalemia. In case of chronic it is dangerous cousing hypervolemia
Sodium bicarbonate used to treatment hyperkalemia.Sodium bicarbonate works by increasing the movement of potassium from the blood into the cells.. Sodium bicarbonate decreases the acidity of the blood, which then reverses the release of potassium out of the cells.
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