Uptodate:There is nothing scary about bicarb
"Potential harms of bicarbonate therapy — Rapid infusions of sodium bicarbonate have a number of potentially adverse effects:
●Increased arterial and tissue capillary PCO2
●Acceleration of lactate generation
●Reduced ionized calcium
●Extracellular fluid (ECF) volume expansion"
"Even with adequate ventilation, the PCO2 is likely to rise at the local tissue level when bicarbonate is infused. Because CO2 readily penetrates cell membranes, this increase in tissue PCO2 may worsen intracellular acidosis even as arterial blood pH increases. This dissociation between tissue and systemic arterial acid-base parameters is magnified in patients with circulatory failure [13,14].
The cerebrospinal fluid (CSF) pH may also fall when bicarbonate is infused for two reasons: first, the mechanism described above increases the PCO2 locally in the brain and CSF; second, amelioration of systemic acidemia (ie, the rise in arterial blood pH) diminishes the drive for hyperventilation, causing the systemic PCO2 to increase. Any systemic and/or local increase in PCO2 will be quickly reflected within the CSF. In contrast, an increased blood bicarbonate concentration is only slowly transmitted to the CSF. Because CSF bicarbonate concentration does not rise as rapidly as the CSF PCO2, "paradoxical" CSF acidemia results and may be associated with neurologic deterioration [15,16]."