Sodium bicarbonate

Question 1

Indications - sodium bicarbonate

Answer 1

❑ 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 2

Dosages: Adult/Pediatric - sodium bicarbonate

Answer 2

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 3

Contraindications - sodium bicarbonate

Answer 3

❑ 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