Sodium bicarbonate

Question 1

Classification - sodium bicarbonate

Answer 1

alkalinizing agent

Question 2

How is sodium bicarbonate supplied?

Answer 2

8.4% preload (1 mEq/mL), 4.2% preload (0.5 mEq/mL)

Question 3

Actions (Pharmacodynamics) - sodium bicarbonate

Answer 3

❑ Systemic alkalinizing agent:

• increases plasma bicarbonate
• buffers excess hydrogen ion concentration
• urine alkalizer by increasing the excretion of free bicarbonate ions
• raises blood pH, thereby reversing the clinical manifestations of acidosis

Question 4

Indications - sodium bicarbonate

Answer 4

❑ metabolic acidosis i.e.; DKA
❑ overdoses with a QRS > 0.12 seconds / v-tach
-tricyclic antidepressant, sympathomimetic, beta / calcium channel blocker, opioid
❑ preexisting Hyperkalemia
❑ Cardiac arrest in special situations; prolonged resuscitation, excited delirium
❑ Rhabdomyolysis
❑ ASA overdose (urine alkalization)

Question 5

Dosages: Adult/Pediatric - sodium bicarbonate

Answer 5

Cardiac arrest in special situations/ Metabolic Acidosis / Overdoses / Rhabdomyolysis / Urinary Alkalization / Hyperkalemia:
1.0 mEq/kg SIVP; repeat (prn) q 10 minutes to achieve hemodynamic stability and QRS narrowing

TCA/ASA overdose: After 1.0 – 2.0 mEq/kg IV bolus and narrowing of QRS, start Infusion 150mEq in a 1000ml D5W or NS and infuse at a rate of 3mL/kg/hr. Can repeat bolus at 0.5mEq/kg

Question 6

Contraindications - sodium bicarbonate

Answer 6

❑ Respiratory acidosis
❑ Early in cardiac arrest (unless a specific reason to administer)
❑ Respiratory and metabolic alkalosis
❑ Hypocalcemia
❑ Avoid extravasation due to risk of tissue irritation / necrosis

Question 7

Precautions - sodium bicarbonate

Answer 7

❑ May inactivate catecholamine’s in solution
❑ Flush well following administration, as it will cause precipitate if mixed with calcium salts (i.e. calcium chloride)
❑ Complete correction of base deficit should be avoided
❑ Is not recommended for routine use for patients in cardiac arrest; unless special resuscitation situation exist

Question 8

Is sodium bicarbonate a major buffer for cardiac arrest?

Answer 8

No. Adequate ventilation and CPR are the major buffer agents, not bicarb.

Question 9

Are ABG results a reliable indicator of acidosis during cardiac arrest?

Answer 9

NO