Sodium Bicarbonate

Question 1

Class

Answer 1

alkalinizing agent

Question 2

Action

Answer 2

Binds with H+ ions to form water and carbion dioxide, and with CO2 excreted by the lungs decrease the acidity of the blood
Cause potassium to shift into cells

Question 3

Indications

Answer 3

Patients with known preexisting metabolic acidosis (DKA) IIa
Hyperkalemia I
Tricyclic antidepressant overdose IIa
Phenobarbital overdose
Alkalinize the urine in drug O.D.’s IIa
After protracted arrests/long resuscitation IIb

Question 4

Dosage/Route

Answer 4

See Hawaii S.O. and Follow ACLS Algorithm (TCA O.D.)

Question 5

Standard Prep

Answer 5

50 mEq/50 cc preloaded syringe

Question 6

Peds Dose

Answer 6

See Hawaii S.O. and Pals Algorithm

Question 7

Contraindications

Answer 7

Metabolic and Respiratory Algorithm

Question 8

Side Effects

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 ABC values
Bicarbonate therapy should be considered only after defib., CPR, ETT, ventilation, and trail of epinephrine
Only aggressive field use may result in metabolic alkalosis
DO NOT MIX WITH CALCIUM CHLORIDE! Precipitates in line if not flushed well.