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Sodium Bicarbonate

Classification

Electrolyte

Alkalinizing agent/buffer

Indications

ACP: Known or suspected hyperkalemia

ACP: Tricyclic or salicylate overdose

ACP: Suspected or confirmed metabolic acidosis

ACP: Pre-treatment prior to weight release in crush injury

Contraindications

Suspected metabolic alkalosis
History of excessive vomiting (i.e., evidence of chloride loss)

Adult dosages

ACP: All indications

1 mEq/kg IV/IO slow push
May repeat 0.5 mEq/kg IV/IO slow push every 10-15 minutes as required
Tricyclic overdoses may require doses as high as 2-3 mEq/kg IV/IO

Pediatric Considerations And Dosing

Follow weight-based dosing

ACP: All indications

Infant: 1-2 mEq/kg very slow IV/IO; may repeat 0.5 mEq/kg every 10-15 minutes as required
- Use 4.2% solution for infants
Child: 1-3 mEq/kg slow IV/IO; may repeat 0.5 mEq/kg every 10-15 minutes as required

Mechanism Of Action

Buffers or neutralizes excess acid (specifically, excess hydrogen ions) raising overall pH.

Pharmacokinetics

Intravenous:

Onset: 1-2 minutes
Peak: 30 minutes
Duration: 1-2 hours

Adverse Effects

Metabolic alkalosis may produce hypoxia due to the leftward/upward shift of the oxyhemoglobin dissociation curve
Muscle tetany
Seizures

Warning And Precautions

Administration of sodium bicarbonate may paradoxically worsen metabolic acidosis if minute ventilation is insufficient. Consider overall physiological state when selecting ventilation strategy.