Use of 2300mg of sodium bicarbonate a day on a patient with CHF, Kidney Failure, and Hypertension, also has a?

Question

I have a patient I take care of as a private duty nurse. She goes to dialysis 3 times a week.The Nurse practitioner in charge of her case has given her a RX of 2300mg of Sodium Bicarbonate daily. This patient is retaining fluid, has kidney failure, and significant high blood pressure. She is on major fluid restriction of only 960cc per day (32 oz). I understand that their may be times that she might have to deal with electrolyte imbalances but why would she need to be on that amount of sodium daily above and over what she already gets in the food she eats. She is also diabetic. I have found deffinate warnings on giving this amount to patients with CHF, Kidney Failure and Hypertension. What would her reasons be for this? I need people who can show medical references to answer please!

Answer 1

no no no, you MUST call the practitioner and demand she give you a rationale for her order. If you don't agree with the rationale, you refuse to give the med. It's your license on the line here. Not the practitioner's license, yours. Because you are the one ultimately giving the medication, you are legally considered ultimately responsible. So call the practitioner and get your answer directly from her. Or don't give the med, and document your reasons for not doing so.

Answer 2

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Answer 3

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Answer 4

You know that sodium polystyrene and Kayexalate are used to encourage postassium exchange in RF. Perhaps your NP is thinking along these lines. Although sodium and fluid restrictions are standard with CHF, RF and HTN and 2300mg/day is a hefty dose. Is your pt. in metabolic acidosis???? I suggest that you hold the bicarb and ask her what the purpose of it is. Make sure she is aware of your pt's dxs. You may know your pt better than she does and it's your license for passing a med you have doubts about.

Answer 5

We must take into account the patients serum osmolarity, potassium level, sodium level (urine and serum), is she in metabolic acidosis like most end stage renal patients? Is he/she scheduled for any test that use dye? It is renal protective when contrast dye is used.

reasons for the baking soda:

1)correction of metabolic acidosis ( are her respirations super high? warning sign)

2)prevention of osteopenia (reverse bone demineralisation) and muscle wasting

3) Remove access potassium (na-K pump)

4) Renal tubular acidosis. The patients renal tubules are damaged and cannot reclaim bicarb or remove acids ( hydrogen ions).

Sodium bicarb is a necessary component of end stage renal disease. The fluid volume overload issue can be addressed during the dialysis.

Answer 6

I know this is a serious question and I have nothing but respect for that on this site, but reading all three answers sounded like the script from "HOUSE" congrats he won a golden globe. Thank you for giving such well thought out answers for this care giver.....