Sodium Bicarbonate 7.5% - 8.4%

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 (alkalinzation 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: Hypersomolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis.

Question 6

Incompatible/Drug Interactions?

Answer 6

Incompatible with other drug infusions

Question 7

Adult Dosage?

Answer 7

• Pre-existing Metabolic or Alkalinization of Blood: 50-100 mEq IV.
• Infusion: 50 mEq of sodium bicarbonate/250 ml of NS
• Cardiac Arrest: First dose usually 1 mEq/kg with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment has been used (such as defib, CPR, intubation, ventilation, more than 1 trail of epinephrine).

Question 8

Pediatric Dosage?

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 Dosage?

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 inter-facility 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 Supply?

Answer 14

Optional: 100 mEq

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 the 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.