Paradoxical CSF acidosis

Paradoxical CSF acidosis is a condition caused by the administration of a large amount of bicarbonate to an acidotic patient, which will result in neurologic dysfunction. When one gives bicarbonate, the equation is shifted towards the left of the screen, towards the generation of CO2. CO2 is very diffusible, and will diffuse across the blood brain barrier and then shift the equation in the cerebral spinal fluid towards the right with a generation of hydrogen ions. Even though additional bicarbonate is being generated in the CNS, the neurons perceive the increase in hydrogen ions and malfunction. The bicarbonate that was administered IV cannot cross the blood brain barrier.