sodium bicarbonate

NATIONAL

CALIFORNIA

VENTURA

policies

category

mechanism

In water, sodium bicarbonate dissociates into a sodium ion (Na⁺) and bicarbonate ion (HCO₃^-). Carbonic anhydrase combines HCO₃^- with a hydrogen ion (H⁺) forming carbonic acid (H₂CO₃) which then breaks down into water (H₂O) and carbon dioxide (CO₂).

indications

Metabolic acidosis: Management of metabolic acidosis caused by certain poisonings including ethylene glycol (antifreeze, aspirin and methanol).
Urine alkalinization: Alkalinization of the urine promotes excretion of some drugs including aspirin and barbiturates.
Hyperkalemia: Sodium bicarbonate lowers of serum potassium by alkalinizing the blood and causing the potassium to shift into the cells (and hydrogen ions to shift out). In crush injuries, potassium is released from ruptured cells causing hyperkalemia.

contraindications

Alkalosis: Often due to vomiting or use of diuretics
Edema, kidney impairment and/or heart failure: Can worsen sodium and fluid retention

dosing

Adult:

IV: 1 mEq/kg/dose

Pediatric:

IV: 1 mEq/kg/dose

administration

IV: For direct IV infusion in emergencies, administer slowly

onset

Rapid

duration

8 to 10 minutes

notes

Reactions with other drugs: Inactivates catecholamines and causes calcium to precipitate. Flush IV tubing before and after administration.
Ventilation: Adequate alveolar ventilation is the mainstay in the control of acid base balance in cardiac arrest.
Volume overload: Monitor patient closely for development of fluid overload (rales, peripheral edema, pink frothy sputum)

dosage form

IV Solution: 8.4% (10 mL, 50 mL)

adverse reactions

Cardiovascular
- Heart failure
- Edema
Dermatologic
- Extravasation can cause tissue necrosis
Endocrine & metabolic
- Hypernatremia
- Hypocalcemia
- Hypokalemia
- Metabolic alkalosis
Respiratory
- Pulmonary edema

structure