II. Efficacy
- No evidence that Sodium Bicarbonate improves outcomes
- Treat acidosis with ventilation and perfusion
- May impair Cardiac Function
III. Indications
- See Sodium Bicarbonate for dosing in Cardiac Arrest
- Documented severe Metabolic Acidosis associated with:
- Unstable hemodynamic state
- Arterial pH <6.9 to 7.0
- Example:
- Diabetic Ketoacidosis with Arterial pH <6.9
IV. Precautions
- Observe for Hypokalemia
- Do not over-correct pH
- Adequate ventilation and perfusion are critical
V. Dosing: Adults (if arterial pH <6.9 to 7.0)
- Sodium Bicarbonate 1 amp (50 meq or 100 mmol)
- Dilute in 400 ml sterile water
- Administer at 200 ml/hour
- Dose full bag or 400 cc of 50 meq if pH <6.9
- Dose half bag or 200 cc of 25 meq if pH 6.9 - 7.0
- If arterial pH <6.9 on recheck in 2 hours
- May repeat dosing as above
VI. Dosing: Children (if arterial pH <7)
- Prepare solution to replace 1-2 meq/kg
- Solution should contain <0.5 meq/ml bicarbonate
- Dilute with appropriate Saline Solution
- Limit infusion rate to <1 meq/kg/hour bicarbonate
- Example: 20 kg child with arterial pH <6.9