Dosing and uses of Sodium bicarbonate
Adult dosage forms and strengths
injectable solution
- 4.2%
- 5%
- 7.5%
- 8.4%
tablet
- 325mg
- 650mg
Cardiac Arrest
Initial: 1 mEq/kg/dose IV x1
Maintenance: 0.5 mEq/kg/dose q10min PRn
Hyperkalemia
50 mEq IV over 5 minutes
Metabolic Acidosis (Non-Life-Threatening)
2-5 mEq/kg IV infusion over 4-8 hr
Other Information
Urine Alkalinization: see sodium bicarbonate Ad
Monitor: serum potassium
Other Indications & Uses
Severe metabolic acidosis (except hypercarbic acidosis)
Of little value in cardiopulmonary resuscitation before circulation has been restored
Pediatric dosage forms and strengths
injectable solution
- 4.2%
- 5%
- 7.5%
- 8.4%
tablet
- 325mg
- 650mg
Cardiac Arrest
Children: as adult
Infants, <2 years old (use 4.2% solution)
- Initial: 1 mEq/kg/min given over 1-2 minutes IV/IO, THEN
- 0.5 mEq/kg IV q10min of arrest
- Not to exceed 8 mEq/kg/day
Other Information
Metabolic acidosis (non-life-threatening): older children: as adult
Urine Alkalinization: see sodium bicarbonate Ad
Monitor: serum potassium
Sodium bicarbonate adverse (side) effects
Frequency not defined
Aggravated CHF
Cerebral hemorrhage
Edema
Hypernatremia
Hypocalcemia
Hypokalemia
Tetany
Metabolic alkalosis
Warnings
Contraindications
Hypersensitivity, metabolic or respiratory alkalosis, hypocalcemia, excessive Cl- loss from vomiting or GI suctioning
Pts at risk of developing diuretic-induced hypochloremic alkalosis
Hypercarbic acidosis
Cautions
Not first-line for resuscitation
Edematous or Na-retaining states, history of CHF, renal impairment, cirrhosis, HTN, children w/ DKA, concurrent corticosteroid use
May cause hypokalemia
Avoid extravasation (may cause chemical cellulitis, tissue necrosis, ulceration & sloughing d/t alkalinity)
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted in breast milk
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Sodium bicarbonate
Onset: 15 min
Duration: 1-2 hr
Therapeutic Range: 24-31 mEq/L
Excretion: urine
Mechanism of action
Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH
Administration
IV Incompatibilities
Additive: ascorbic acid, carboplatin, carmustine, ciprofloxacin, cisplatin, dobutamine, dopamine, epinephrine, hydromorphone, imipenem-cilastatin, labetalol, meperidine (?), meropenem, morphine, norepinephrine, penicillin G potassium, pentazocine, pentobarbital, procaine, sodium lactate, streptomycin, succinylcholine, vancomycin(?), vit B/C
Syringe: bupivacaine(?), epinephrine(?), etidocaine, glycopyrrolate, lidocaine(?), mepivacaine, metoclopramide, thiopentaL
Y-site: allopurinol, amiodarone, ampho B cholesterylSO4, CaCl2, Ca gluconate, ciprofloxacin(?), cisatarcurium(?), doxorubicin liposomal, fenoldopam, hetastarch, idarubicin, imipenem-cilastatin, inamrinone, leucovorin, midazolam, nalbuphine, ondansetron, oxacillin, sargramostim, verapamil, vincristine, vindesine, vinorelbine
Not spec: diazepam, tetracycline
IV Compatibilities
Additive: aminophylline, ampho B, atropine, Ca gluconate, clindamycin, erythromycin, heparin, hydrocortisone, KCl, verapamiL
Syringe: heparin
Y-site: heparin, morphine, KCl, vancomycin, vit B/C
IV Administration
Administered IV, either undiluted or diluted in other fluids, or
By SC if diluted to isotonicity
Storage
Store at controlled room temperature
Protect from freezing & temp >40°C
Do not use if unclear or contains a precipitate
