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Sodium Bicarbonate in Severe Metabolic Acidosis
Aka: Sodium Bicarbonate in Severe Metabolic Acidosis
- See Also
- Sodium Bicarbonate
- Efficacy
- No evidence that Sodium Bicarbonate improves outcomes
- Treat acidosis with ventilation and perfusion
- May impair Cardiac Function
- 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
- Precautions
- Observe for Hypokalemia
- Do not over-correct pH
- Adequate ventilation and perfusion are critical
- 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
- 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
- Sodium should be <155 meq/L (NS concentration)
- Every bicarb ampule contains 2000 meq/L Sodium
- Limit infusion rate to <1 meq/kg/hour bicarbonate
- Example: 20 kg child with arterial pH <6.9
- Maximum replacement is 40 meq bicarbonate
- Dilute 40 ml NaHCO3 in 500 cc in 1/4 NS
- Contains 40 meq Na + 38 meq Na = 78 meq Na
- Sodium concentration is 156 meq/L (same as NS)
- Limit this 20 kg child's rate to 20 meq/hour
- This child's rate should be <250 cc/hour