If an infant during resuscitation shows metabolic acidosis with low bicarbonate, which intervention is indicated?

• A. Hyperventilation
• B. Suction and check the airway
• C. Administer sodium bicarbonate
• D. Echocardiogram

Answer: (C)

Metabolic acidosis during resuscitation means the infant’s tissues have produced a lot of acid (often from anaerobic metabolism) and the buffering systems are depleted, so the pH falls and bicarbonate drops. Giving sodium bicarbonate directly replenishes the buffer, helping to neutralize hydrogen ions and raise the pH. This can improve enzymatic function and support the heart’s ability to respond to CPR, especially when the acidosis is severe enough to compromise perfusion and hemodynamics.

administer bicarbonate is considered after you’ve established and optimized ventilation and circulation, and the acidosis is profound enough that simple restoration of oxygenation and perfusion may not quickly correct the acid-base status. Dosing should be careful and weight-based, with ongoing monitoring of electrolytes and fluid balance, because bicarbonate administration can shift potassium and sodium and generate carbon dioxide that must be expelled by adequate ventilation. In contrast, simply suctioning or checking the airway, or pursuing an echocardiogram, do not directly address the underlying acid-base disturbance during ongoing resuscitation.