Sodium Bicarbonate

Question 1

Drug Class

Answer 1

Systemic hydrogen ion buffer, alkalizing agent

Question 2

Mechanism of Action

Answer 2

Reacts with hydrogen ions to form water and carbon dioxide, correcting metabolic acidosis. Increases blood and urinary pH by releasing a bicarbonate ion to neutralize H+ concentrations

Question 3

Indications and Contraindications

Answer 3

Indications: Cardiac arrest with suspected hyperkalemia/ TCA overdose; QRS prolongation in suspected TCA overdose, crush syndrome

Contraindications: Known metabolic or respiratory alkalosis, hypokalemia, hypernatremia, hypocalcemia. Caution in aptients with heart failure/ renal disease as that will cause high sodium concentrations

Question 4

Effects & Interactions

Answer 4

Effects: Electrolyte imbalance, heart failure, pulmonary edema from sodium overload, tremors twitching or seizures from alkalosis

Interactions: May deactivate sympathomimetics, increases effects of amphetamines and decreases effects of benzos and TCAs

Question 5

Dosage and Administration

Answer 5

Adult: 1 mEq/kg (milliequivalents) slow IV/IO push

Peds: 1 mEq slow IV/IO push

4.2% concentration recommended for infants younger than 1 month

Medical command for repeat dosing!

Question 6

Duration of Action

Answer 6

Onset: seconds Peak: less than 15 minutes Duration: 1-2 hours