II. Precautions
- Sodium Bicarbonate is not a first line drug for Resuscitation
- Treat acidosis with ventilation and perfusion (bicarbonate may suppress respiratory drive)
- Bicarbonate has not been shown to improve survival
- Bicarbonate may transiently depress CV parameters (related to Electrolyte shifts, Hypocalcemia, Hypokalemia)
- Cardiac Function
- Coronary Artery perfusion
III. Indications
- Documented severe Metabolic Acidosis associated with:
- See Sodium Bicarbonate in Severe Metabolic Acidosis
- Prolonged Cardiac Arrest
- Unstable hemodynamic state
- Diabetic Ketoacidosis with Arterial pH <6.9
- Pulmonary Hypertension in the newborn
- Associated with Base Excess below -10
- Significant bicarbonate loss (e.g. Renal Tubular Acidosis, severe Diarrhea)
- Hyperkalemia
- Medication overdosage (alkalinize serum and urine)
IV. Preparations: Intravenous Concentrations
- Bicarbonate 4.2% (0.5 meq/ml in 10 ml ampule)
- Child under 3 months old
- Bicarbonate 8.4% (1 meq/ml in 50 ml prefilled syringe)
- Equivalents of Sodium Bicarbonate (NaHCO3)
- Standard bicarb ampule is 50 meq in 50 ml
- Equivalent to 8.4 grams/dl or 4.2 grams/50 ml
- One ampule = 50 meq = 4.2 grams = 50 mmoles
- Do not use 8.4% in child under 3 months old
- Bicarbonate 8.4% is hyperosmolar (2000 mosm/L)
- Intraventricular bleeding risk in Preterm Infant
- Use in Child over 3 months old and adults
- Equivalents of Sodium Bicarbonate (NaHCO3)
- Preparation for infusion
- Sodium Bicarbonate 8.4%: 1 amp (50 meq or 50 mmol)
- Dilute NaHCO3 in 400 ml of D5W
- Do not administer at a rate >200 ml/hour
V. Dosing: Intravenous Emergency dosing
- Precaution
- Bicarbonate recommendations vary
- Use this as a general resource only
- Base actual dosing on standard Pharmacology texts
- IV infusion must be slow even in emergency
- Initial Dose: 1 meq/kg IV or IO over 1-2 minutes
- Additional Dose: 0.5 meq/kg IV or IO every 10 minutes
- Repeat for persistent severe Metabolic Acidosis
- Base repeat dosages on Arterial Blood Gas
- Continuous Infusion: 5% bicarbonate (297.5 meq/500ml)
VI. Dosing: Adults for Urine Alkalinization
VII. Administration guidelines
- Do not give by endotracheal route
- Irrigate IV or IO tubing with Normal Saline
- Irrigate before and after bicarbonate infusion
VIII. Adverse reactions
- Overcompensation results in Metabolic Alkalosis
- Impaired tissue Oxygen Delivery
- Hypokalemia (intracellular shift)
- Hypocalcemia
- Lowered fibrillation threshold
- Sodium and water overload
- Inactivates Catecholamines
- Precipitates Calcium Salts
- Extravasation into subcutaneous tissue
- Scleroses small veins
- Local Chemical Burn
-
Intracranial Hemorrhage in newborns (hyperosmolality)
- Use only 4.2% bicarbonate in under age 3 months
IX. References
- Yavorsky and Glauser (2023) Crit Dec Emerg Med 37(9): 24-9
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Related Studies
| sodium bicarbonate (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| SODIUM BICARBONATE 8.4% VIAL | Generic | $0.18 per ml |