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Sodium Bicarbonate

    Brands

    DEA Class; OTC

    Common Brand Names; 

    • Alkalinizing Agents

    Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH

    Indicated for

    • Cardiac Arrest
    • Hyperkalemia
    • Metabolic Acidosis

    Hypersensitivity

    Injection

    • Chloride loss due to vomiting or from continuous gastrointestinal suction
    • Currently treated with diuretics
    • Aggravated CHF
    • Cerebral hemorrhage
    • Edema
    • Hypernatremia
    • Hypocalcemia
    • Hypokalemia
    • Tetany
    • Metabolic alkalosis
    • Belching
    • Gastric distension
    • Pulmonary edema
    • Hypernatremia
    • Hyperosmolality
    • Intracranial acidosis
    • Milk-alkali syndrome

    Not first-line for resuscitation

    Use with caution in patients with congestive heart failure, severe renal insufficiency, edematous or sodium-retaining states, HTN, children with DKA, and concurrent corticosteroid use

    IV administration can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema

    Avoid extravasation (may cause chemical cellulitis, tissue necrosis, ulceration & sloughing due to alkalinity)

    Potassium depletion may predispose to metabolic alkalosis and coexistent hypocalcemia may be associated with carpopedal spasm as plasma pH rises; treat appropriately before or during the infusion to minimize the risk of such electrolyte imbalance

    Pregnancy

    Unknown if fetal harm may occur when administered to pregnant females or can affect reproduction capacity

    Use if clearly needed

    Lactation

    Unknown if excreted in breast milk

    Adult

    cardiac Arrest

    Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit

    Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established

    Hyperkalemia

    50 mEq IV over 5 minutes

    Metabolic Acidosis

    Non-life-threatening: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH

    Severe (except hypercarbic acidosis): 90-180 mEq/L (~7.5-15 g) at a rate of 1-1.5 L (first hour); adjust for further management as needed

    Pediatric

    Cardiac Arrest

    Infants, <2 years (use 4.2% solution)

    • Initial: 1 mEq/kg/min given over 1-2 minutes IV/IO, THEN
    • 1 mEq/kg IV q10min of arrest
    • Not to exceed 8 mEq/kg/day

    ≥2 years

    • Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit
    • Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established

    Metabolic Acidosis (Non-Life-Threatening)

    Older children: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH

    0.25-2mEq/kg IV infusion can be considered for acidosis with a pH <7.0-7.2

    Sodium bicarbonate 

    injectable solution

    • 4%
    • 4.2%
    • 7.5%
    • 8.4%

    tablet

    • 325mg
    • 650mg