Sodium Bicarbonate

Question 1

Class

Answer 1

Alkalinizing agent

Question 2

Action

Answer 2

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

Question 3

Indications

Answer 3

Pt’s with known preexisting metabolic acidosis (DKA) IIa.
Hyperkalemia I.
Tricyclic antidepressant over dose IIa.
Phenobarbital overdose.
Alkalinize the urin in drug OD’s IIa.
After protracted arrests/long resuscitation IIb.

Question 4

Dosage/Route

Answer 4

See Hawaii SO and PALS algorithm.

Question 5

Contraindications

Answer 5

Metabolic and Respiratory alkalosis

Question 6

Side effects

Answer 6

Paradoxical intracellular/tissue acidosis due to CO2 generation and inadequate ventilations to rid CO2 which readily diffuses across cell membrane.
Hypernatremia from large sodium load.
Hyperosmolarity from large sodium load.
May shift decrease in the release of O2 by hgb to the tissues.
Metabolic alkalosis.

Question 7

Precautions

Answer 7

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