Sodium Bicarbonate (Bicarb, NaHC03)

Question 1

Sodium Bicarb - Class

Answer 1

Alkalizing agent

Question 2

Sodium Bicarb - Actions

Answer 2

Raises the pH of blood plasma by buffering excess hydrogen ions

Question 3

Sodium Bicarb - Indications

Answer 3

• Acidosis following cardiac arrest - for long arrest interval (relative indication) with effective ventilation & ROSC
• Suspected hyperkalemia - e.g. in hemodialysis pt with wide QRS, peaked T waves, and bradycardia
• Tricyclic OD (altered LOC, tachycardia, prolonged QRS)

Question 4

Sodium Bicarb - Dosage/Route

Answer 4

After cardiac arrest & ROSC
- 1 mEq/kg IVP

Suspected hyperkalemia/Tricyclic OD
- 1 mEq/kg slow IVP

Question 5

Sodium Bicarb - Side Effects

Answer 5

Possible metabolic alkalosis

Question 6

Sodium Bicarb - Contraindications

Answer 6

First 10 min of cardiac arrest unless hyperkalemia suspected

Question 7

Sodium Bicarb - Special Information

Answer 7

Flush tubing between admin of other meds

• Decreases effectiveness of epi if mixed
• Precipitates with calcium chloride if mixed

Tricyclic OD
- Slight alkalosis promotes binding of tricyclic to plasma proteins, thus negating the toxic effects on the body

Hemodialysis Pt

• Assess effectiveness in symptomatic hemodialysis pt by reevaluating the ECG
• Slight alkalosis causes potassium to shift from the extracellular space, resulting in a reduction of serum potassium levels

Adequate ventilation & CPR, not Bicarb, are the major “buffer agents” in cardiac arrest

Near Drowning Pt (hypoxic & acidotic)
- Reverses acidosis

Question 8

Sodium Bicarb - Pediatric Note

Answer 8

Refer to Pediatric Drug Guide