Sodium bicarbonate during resuscitation may increase which of the following?

• A. Cerebral blood flow
• B. Intracellular acidosis
• C. Myocardial function
• D. Renal perfusion

Answer: (B)

During resuscitation, giving sodium bicarbonate can raise the pH outside cells, but the buffering process produces carbon dioxide. CO2 readily crosses cell membranes, and inside the cell it forms carbonic acid that dissociates into H+ and bicarbonate, increasing hydrogen ion concentration and lowering intracellular pH. This paradoxical rise in intracellular acidity can impair cellular function, including myocardial contractility, even as the extracellular pH improves. Because of this, bicarbonate does not reliably improve cerebral blood flow or renal perfusion and may worsen cellular performance by promoting intracellular acidosis.