Bicarb/ Sodium Bicarbonate

Question 1

Bicarb Class

Answer 1

Alkalizing Agent

Question 2

Bicarb Action

Answer 2

Increases plasma bicarbonate, which can buffer metabolic acids and move TCAs and phenobarbital off receptor sites and back into circulation

Question 3

Bicarb Indication

Answer 3

• Preexisting Metabolic Acidosis (severe hypoxia, late cardiac arrest)
• Hyperkalemia
• Tricyclic or Phenobarbital Overdose

Question 4

Bicarb Contraindications

Answer 4

• None in severe hypoxia and late cardiac arrest
• Metabolic and Respiratory alkalosis
• Severe pulmonary edema
• Hypokalemia
• Hypocalcemia
• Hypernatremia

Question 5

Bicarb Precautions

Answer 5

• can worsening intracellular acidosis
• CHF (may worsen)
• Pregnancy (C)
• Infiltration can cause tissue necrosis
• Renal disease

Question 6

Bicarb Dosage

Answer 6

Adults:
1 mEq/kg IV may repeat ½ dose 10 min after.
*OPTIONAL TCA Overdose/CRUSH Injury: INFUSION: 50-100 mEq/1000 ml, run at 150 ml/hr, titrated for effect
Pediatrics:
1 mEq/kg IV may repeat ½ dose 10 min after.
*OPTIONAL TCA Overdose INFUSION: 50-100 mEq/1000 ml, run at 150ml/hr, titrated for effect

Question 7

Bicarb Onset/ Duration

Answer 7

• Onset: 2-10 minutes

* Duration: 30-60 minutes

Question 8

Bicarb Side Effects

Answer 8

• Alkalosis
• Hyperirritability, Seizures
• Tetany (electrolyte imbalance)
• Hypernatremia
• Hyperosmolality
• Cardiac & respiratory arrest
• Lowering of serum K
• Increased binding of calcium to serum proteins
• Decreased fibrillation threshold
• Sodium and water overload
• Inhibition of oxygen release to tissue

Question 9

Bicarb Interactions

Answer 9

• Calcium salts will form a precipitate and clog the IV line
• Most sympathomimetics will be deactivated by alkaline solutions
• Use relatively early in the setting of confirmed TCA overdoses, tachycardia (even before QRS widening) and CNS depression are symptomatic enough to initiate alkalinization. By the time you get to hypotension, you often are close to seizures and may be too late
• Ensure IV is patent to avoid tissue sloughing at the injection site
• Also be sure to flush IV line before and after administration to avoid inactivating sympathomimetics and precipitating with CaCl