Sodium Bicarbonate (Na HCO3)

Question 0

Actions (3)

Answer 0

1. Increases blood pH
2. It combines with hydrogen ions to form carbonic acid
3. Decreases precipitation of myoglobin in renal tubules in crush syndrome

Question 1

Drug classification

Answer 1

Alkalinizing agent (hydrogen ion buffer)

Question 2

Indication (3)

Answer 2

1. Crush syndrome
   - suspected hyperkalemia
   - crush force or entrapment more than four hours
2. Cardiopulmonary arrest
   - suspected hyperkalemia (dialysis patient)
   - downtime more than 20 minutes
3. Known pre-existing bicarbonate responsive acidosis
   - trycyclic overdose
   - aspirin overdose
   - diphenhydramine overdose
   - diabetic ketoacidosis
   - cocaine overdose

Question 3

Contraindication

Answer 3

Not significant in indications listed above

Question 4

Adverse effects - metabolic (4)

Answer 4

Metabolic alkalosis*
Hypocalcemia
Hypokalemia
Tissue acidosis

Question 5

Adverse effects - respiratory

Answer 5

Pulmonary edema*

Question 6

Adverse effects - neurological (4)

Answer 6

Headache
Confusion
Tetany*
Seizures*

Question 7

Administration - cardiac arrest

Answer 7

1 mEq/kg IVP

May repeat 0.5 mEq/kg IVP every 10-15 minutes

Question 8

Administration - crush syndrome

Answer 8

1 mEq/kg IVPB, added to first 1000mL NS

Question 9

Pediatrics - cardiac arrest

Answer 9

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

Question 10

Pediatrics - crush syndrome

Answer 10

Same as adult

Question 11

Onset

Answer 11

Immediate

Question 12

Duration

Answer 12

30-60 minutes

Question 13

Precautions

Flush IV tubing before and after administration

Answer 13

Rationale

Precipitates with calcium chloride and inactivates catecholamines (epinephrine)

Question 14

Precautions

Verify IV patency before administration

Answer 14

Rationale

Causes tissue necrosis if infused into the interstitial space

Question 15

Precaution

Perform effective CPR and ventilation to reverse anaerobic metabolism

Answer 15

Rationale

Bicarbonate produces CO2, which diffuses across cell membranes more rapidly than bicarbonate and therefore may increase intracellular acidosis

Question 16

Note - cardiac arrest

Answer 16

When possible, blood gas analysis should guide bicarbonate administration

Question 17

Note - crush syndrome

Answer 17

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

Question 18

How supplied

Answer 18

50 mEq in 50 mL pre-filled syringe

Question 19

How supplied for peds

Answer 19

10 mEq in 10 mL pre-filled syringe