Dosing and uses of Sodium bicarbonate (Antidote)
Adult dosage forms and strengths
IV solution
- 4%
- 4.2%
- 7.5%
- 8.4%
Cocaine Toxicity
1-2 mEq/kg IV push bolus
Cyanide Toxicity
1-2 mEq/kg IV push bolus
Salicylate Toxicity
100-150 mEq IV with 40-80 mEq of potassium chloride in each liter of D5W; administer at 150-250 mL/hr to maintain higher than normal urine output
Barbiturate Toxicity
1 mEq/kg IV bolus, followed by an IV drip of 1000 mL of D5W to which 2-3 ampules of sodium bicarbonate are added, initiate drip rate at 200 mL/hr, titrate drip rate to blood pH (7.45) and urinary pH (7.5-8)
Cardiac Arrest
Initial: 1 mEq/kg/dose IV push bolus
Maintenance: 0.5 mEq/kg/dose q10min or as indicated by arterial blood gases
Tricyclic Antidepressant Toxicity
Use if QRS >100-200 ms or hypotension
Initial bolus: 1-2 mEq/kg IV push over 1-2 minutes; not to exceed 100 mEq/dose
Follow-up infusion: 100-150 mEq in 1 L D5/0.45% NaCl infused 100-200 mL/hr IV; titrate infusion to achieve blood pH of 7.45-7.55
Other Indications & Uses
All Class 1 antidysryhthmics (quinidine, procainamide, encainide, flecainide; cardiac conduction defect)
Antihistamines (H1 blockers & nonsedating varieties)
Amantidine
Ethylene glycol, methanoL
Na+ channel blocking drugs in generaL
Salicylates, phenobarbital, chlorpropamide (see Urinary Alkalinization)
Pediatric dosage forms and strengths
IV solution
- 4%
- 4.2%
- 7.5%
- 8.4%
Metabolic Acidosis
Dosage based on blood gases and pH measurements (if available)
If acid-base status unavailable, older children may receive 2-5 mEq/kg IV infusion over 4-8 hr; titrate infusion rate to maintain pH of 6-7
Sodium bicarbonate (Antidote) adverse (side) effects
Frequency not defined
Tetany
Hypernatremia
Alkalosis
Gastric distension
Hypocalcemia
Hyperosmolality
Milk-alkali syndrome
Pulmonary edema
Pregnancy and lactation
Pregnancy category: C
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 (Antidote)
Mechanism of action
Increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations
1g of sodium bicarbonate is equivalent to 11.9 mEq each of sodium and bicarbonate
Pharmacokinetics
8-10 min (PO); 1-2 hr (IV)
Excretion: Urine (<1%)
Onset of action: Rapid (PO); 15 min (IV)
