Additionally, inotropics with vasoconstricting properties should be administered. In the next few paragraphs, I will explain why each of these variables must be evaluated. A pH less than 7.2 causes profoundly decreased myocardial contractility and it impairs the effectiveness of catecholamines. The adverse effects of sodium bicarbonate include hyperosmolarity, an acute decreased in intracellular pH, hypernatremia, decreased ionized Ca concentration, and a left shift of the oxyHb dissociation curve. Rapid administration of sodium bicarbonate causes an abrupt increase in pH equal to decreased ionized calcium due to alterations in the CHON binding.
Hypocalcemia impairs cardiac contractility and limits the pressor effect of catecholamines.
Calcium solution should be administered in 10-15 minutes to prevent bradycardia. You must check the BUN and creatinine to evaluate renal function. In hypovolemia, the BUN generally rises out of proportion to the creatinine, but significant elevations in creatinine may occur with isolated hypovolemia without underlying renal disease. Inotropic agents have a distinct mechanism of action. Dopamine is an intermediate product in the catecholamine pathway.