Sodium Bicarbonate

Question 1

class

Answer 1

buffer

Question 2

mechanism of action

Answer 2

Buffers H+ and increases pH

Question 3

indications and field use

Answer 3

 Pre-existing metabolic acidosis
 Poisoning of aspirin, cyclic antidepressants (alkalinization of blood)
 Cardiac arrest after other interventions and ventilation is adequate

Question 4

contraindications

Answer 4

alkalosis

Question 5

adverse reactions

Answer 5

CV: Congestive heart failure, edema secondary to sodium overload.
Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may
cause extracellular alkalosis and intracellular acidosis.

Question 6

incompatibilities/drug reactions

Answer 6

Incompatible with other drug infusions

Question 7

adult dose

Answer 7

Pre-existing Metabolic Acidosis or Alkalinization of Blood: 50-100 mEq IV per
medical control authority.
Infusion: 50 mEq of sodium bicarbonate/250 ml of NS or as determined by medical
control.
Cardiac arrest: First dose usually 1 mEq/kg (or as determined by blood gas analysis),
with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other
standard treatment (defibrillation, CPR, intubation, ventilation and more than one trial of
epinephrine) has been used.

Question 8

peds dose

Answer 8

1 mEq/kg IV or IO slowly, if ventilation is adequate according to medical control
authority. Can contribute to acidosis and cause fluid overload.

Question 9

neonatal dose

Answer 9

1 mEq/kg IV or IO of 4.2% slowly. Waste 25 ml of 8.4% solution and add 25 ml of NS from IV bag, each ml will contain 0.5 mEq of sodium bicarbonate

Question 10

routes of administration

Answer 10

IV bolus; IV infusion

For IV infusion to be monitored on interfacility transports, infusion pump is required

Question 11

onset of action

Answer 11

seconds

Question 12

peak effects

Answer 12

1-2 minutes

Question 13

duration of action

Answer 13

10 minutes

Question 14

AZ drug box minimum

Answer 14

optional 100mEq

Question 15

special notes

Answer 15

 Flush tubing before and after administration, especially with concurrent use of calcium
chloride.
 Sodium bicarbonate administration should be considered only for treatment of
documented severe acidosis associated with prolonged cardiac arrest or an unstable
hemodynamic state, hyperkalemia or certain poisonings (i.e. cyclic antidepressants, ASA,
phenobarbital, etc.).
 In premature infants hyperosmolarity from undiluted sodium bicarbonate has been
correlated with an increased risk for periventricular-intraventricular hemorrhage.
 Severe tissue necrosis will occur with extravasation.