Sodium Bicarbonate in Severe Metabolic Acidosis

Aka: Sodium Bicarbonate in Severe Metabolic Acidosis

1. See Also
   1. Sodium Bicarbonate
2. Efficacy
   1. No evidence that Sodium Bicarbonate improves outcomes
   2. Treat acidosis with ventilation and perfusion
   3. May impair Cardiac Function
3. Indications
   1. See Sodium Bicarbonate for dosing in Cardiac Arrest
   2. Documented severe Metabolic Acidosis associated with:
      1. Unstable hemodynamic state
      2. Arterial pH <6.9 to 7.0
   3. Example:
      1. Diabetic Ketoacidosis with Arterial pH <6.9
4. Precautions
   1. Observe for Hypokalemia
   2. Do not over-correct pH
   3. Adequate ventilation and perfusion are critical
5. Dosing: Adults (if arterial pH <6.9 to 7.0)
   1. Sodium Bicarbonate 1 amp (50 meq or 100 mmol)
   2. Dilute in 400 ml sterile water
   3. Administer at 200 ml/hour
      1. Dose full bag or 400 cc of 50 meq if pH <6.9
      2. Dose half bag or 200 cc of 25 meq if pH 6.9 - 7.0
   4. If arterial pH <6.9 on recheck in 2 hours
      1. May repeat dosing as above
6. Dosing: Children (if arterial pH <7)
   1. Prepare solution to replace 1-2 meq/kg
   2. Solution should contain <0.5 meq/ml bicarbonate
   3. Dilute with appropriate Saline Solution
      1. Sodium should be <155 meq/L (NS concentration)
      2. Every bicarb ampule contains 2000 meq/L Sodium
   4. Limit infusion rate to <1 meq/kg/hour bicarbonate
   5. Example: 20 kg child with arterial pH <6.9
      1. Maximum replacement is 40 meq bicarbonate
      2. Dilute 40 ml NaHCO3 in 500 cc in 1/4 NS
         1. Contains 40 meq Na + 38 meq Na = 78 meq Na
         2. Sodium concentration is 156 meq/L (same as NS)
      3. Limit this 20 kg child's rate to 20 meq/hour
         1. This child's rate should be <250 cc/hour