Sodium Bicarbonate

Question 1

Class

Answer 1

Alkalinizng agent

Question 2

Actions (2)

Answer 2

• Bind with H+ ions to form water and CO2, and with CO2 excreted by the lungs decreases the acidity of the blood
• Cause K+ to shift into cells

Question 3

Indications (6)

Answer 3

• Pts with known preexisting metabolic acidosis (DKA) IIa
• Hyperkalemia I
• TCA OD IIa
• Phenobarbital OD
• Alkalinize the urine in drug ODs IIa
• After protracted arrests/long resuscitation IIb

Question 4

Dosage/Route

Answer 4

See HI S.O. and follow ACLS Algorithm (TCA OD)

Question 5

Standard Prep

Answer 5

50 mEq/50 cc preloaded syringe

Question 6

Peds Dose

Answer 6

See HI S.O. and PALS Algorithm

Question 7

Contraindication

Answer 7

Metabolic and Respiratory Alkalosis

Question 8

Side Effects (5)

Answer 8

• Paradoxical intracellular/tissue acidosis due to CO2 generation and inadequate ventilations to rid CO2 which readily diffuses across cell membranes
• Hypernatremia from large sodium load
• Hyperosmolarity from large sodium load
• May shift oxyhemoglobin dissociation curve to the left which causes a decrease in the release of O2 by hgb to the tissues
• Metabolic alkalosis

Question 9

Precautions

Answer 9

• Dosing should ideally be governed by ABG values
• Bicarb therapy should be considered only after defib, CPR, ETT, ventilation, & trial of epinephrine
• Overly aggressive field use may result in metabolic alkalosis
• DO NOT MIX WITH CALCIUM CHLORIDE! Precipitates in line if not flushed well