Sodium Bicarbonate (Na HCO3) Flashcards
Actions (3)
- Increases blood pH
- It combines with hydrogen ions to form carbonic acid
- Decreases precipitation of myoglobin in renal tubules in crush syndrome
Drug classification
Alkalinizing agent (hydrogen ion buffer)
Indication (3)
- Crush syndrome
- suspected hyperkalemia
- crush force or entrapment more than four hours - Cardiopulmonary arrest
- suspected hyperkalemia (dialysis patient)
- downtime more than 20 minutes - Known pre-existing bicarbonate responsive acidosis
- trycyclic overdose
- aspirin overdose
- diphenhydramine overdose
- diabetic ketoacidosis
- cocaine overdose
Contraindication
Not significant in indications listed above
Adverse effects - metabolic (4)
Metabolic alkalosis*
Hypocalcemia
Hypokalemia
Tissue acidosis
Adverse effects - respiratory
Pulmonary edema*
Adverse effects - neurological (4)
Headache
Confusion
Tetany*
Seizures*
Administration - cardiac arrest
1 mEq/kg IVP
May repeat 0.5 mEq/kg IVP every 10-15 minutes
Administration - crush syndrome
1 mEq/kg IVPB, added to first 1000mL NS
Pediatrics - cardiac arrest
1 mEq/kg SLOW IVP at 10mL/min
May repeat 0.5 mEq/kg IVP every 10-15 minutes
Rarely indicated in pediatric full arrest
Pediatrics - crush syndrome
Same as adult
Onset
Immediate
Duration
30-60 minutes
Precautions
Flush IV tubing before and after administration
Rationale
Precipitates with calcium chloride and inactivates catecholamines (epinephrine)
Precautions
Verify IV patency before administration
Rationale
Causes tissue necrosis if infused into the interstitial space
Precaution
Perform effective CPR and ventilation to reverse anaerobic metabolism
Rationale
Bicarbonate produces CO2, which diffuses across cell membranes more rapidly than bicarbonate and therefore may increase intracellular acidosis
Note - cardiac arrest
When possible, blood gas analysis should guide bicarbonate administration
Note - crush syndrome
Use sodium bicarbonate only if the following signs of hyperkalemia are present
Peaked T waves
Possibly absent P waves
Widened QRS complexes
Crush force or entrapment is more than 4 hours
How supplied
50 mEq in 50 mL pre-filled syringe
How supplied for peds
10 mEq in 10 mL pre-filled syringe
