Sodium bicarbonate: Difference between revisions

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Hyperosmolar solution.
==Administration==
Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial
*Type: 8.4% is common cardiac administered per
*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325 mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
*Routes of Administration: IV
*Common Trade Names: N/A
{{Dosing Variables}}
==Adult Dosing==
===Cardiac Arrest===
{{#var:bicarbmax}} mL (1 amp) IV push for severe acidemia and patient is adequately ventilated
*Frequency<ref>eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749</ref>:
**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
**0.5 mEq/kg/dose q10min
**OR tailor to serial ABGs


'''Indications:'''
===IV drip===
-Hyperkalemia
*150 mEq/1000 mL inD5W
-decr pain due to LA
==Pediatric Dosing==
'''Toxicological indications-'''
===Cardiac Arrest===
Cardiotoxicity secondary to fast sodium channel blockade-TCA,Bupropion,Chloroquine/hydroxychloroquine,Dextropropoxyphene,Propranolol.
{{#var:bicarb}} mL/kg IV push for severe acidemia and patient is adequately ventilated
Prevent redistribution of drug to CNS-Severe salicylate poisoning.
Profound life-threatening metabolic acidosis-Cyanide,Toxic alcohol poisoning,Isoniazid overdose.
Enhance urinary drug elimination-Salicylate,Phenobarbitone intoxication.
Increase urinary solubility-Methotrexate toxicity.Drug-induced rhabdomyolysis


'''Contraindications:'''
==Special Populations==
Acute pulmonary oedema
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
Hypokalaemia
*[[Lactation risk categories|Lactation risk]]:
Metabolic or respiratory alkalosis
===Renal Dosing===
Poorly controlled congestive cardiac failure
*Adult:
Renal failure
*Pediatric:
Severe hypernatraemia.
===Hepatic Dosing===
*Adult:
*Pediatric:


'''Adverse drug reactions:'''
==Contraindications==
Alkalosis (serum pH >7.6 is detrimental to cardiovascular function)
*Allergy to class/drug
Hypernatraemia and hyperosmolarity
Fluid overload and acute pulmonary oedema
Hypokalaemia
Local tissue inflammation secondary to extravasation


'''Administration:'''
==Adverse Reactions==
'''Cardiotoxicity secondary to fast sodium channel blockade:'''
===Serious===
Resuscitation from severe cardiotoxicity (cardiac arrest, ventricular arrhythmias and hypotension)
Give repeated boluses of 2 mmol/kg IV until cardiovascular stability is achieved
'''Maintenance of serum alkalinisation in severe cardiotoxicity:'''
Consider following resuscitation in the presence of ventricular arrhythmias, hypotension, or a markedly wide QRS complex (>140 ms)
Commence an infusion of 100 mmol sodium bicarbonate diluted in 1000 mL normal saline at 250 mL/hour
Hourly ABGs and maintain serum pH 7.50–7.55
Cease following resolution of cardiovascular toxicity as determined by clinical and ECG criteria
'''Prevention of redistribution of salicylate to CNS:'''
Maintain pH above 7.4 at all times
Intubated pt-serum pH may be maintained >7.4 by hyperventilation
Unwell un-intubated patient with salicylate poisoning-Give sodium bicarbonate 2 mmol/kg IV bolus,Then intubate, hyperventilate and recheck ABGs.
Serum alkalinisation is maintained until definitive care with haemodialysis.
'''Urinary alkalinisation:'''
Correct hypokalaemia if present.Give 1–2 mmol/kg sodium bicarbonate IV bolus
Commence infusion of 100 mmol sodium bicarbonate in 1000 mL 5% dextrose at 250 mL/hour
20 mmol of KCl may be added to infusion to maintain normokalaemia
Monitor serum bicarbonate and potassium at least every 4 hours
Regularly dipstick urine and aim for urinary pH >7.5 .Continue until resolving clinical and laboratory evidence of toxicity.


'''Specific considerations:'''
===Common===
'''Pregnancy:''' No restriction on use
 
'''Lactation:''' No restriction on use
==Pharmacology==
'''Paediatric:''' Doses are the same as for adults on mmol/kg basis. Reduced fluid volumes should be used in children.
*Half-life:  
*Metabolism:  
*Excretion:  
 
==Mechanism of Action==
 
==Comments==
 
==See Also==
 
==References==
<references/>
[[Category:Drugs]]

Revision as of 12:14, 15 February 2016

Administration

  • Type: 8.4% is common cardiac administered per
  • Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325 mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
  • Routes of Administration: IV
  • Common Trade Names: N/A


Adult Dosing

Cardiac Arrest

50 mL (1 amp) IV push for severe acidemia and patient is adequately ventilated

  • Frequency[1]:
    • 1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
    • 0.5 mEq/kg/dose q10min
    • OR tailor to serial ABGs

IV drip

  • 150 mEq/1000 mL inD5W

Pediatric Dosing

Cardiac Arrest

1 mL/kg IV push for severe acidemia and patient is adequately ventilated

Special Populations

Renal Dosing

  • Adult:
  • Pediatric:

Hepatic Dosing

  • Adult:
  • Pediatric:

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:

Mechanism of Action

Comments

See Also

References

  1. ↑ eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749
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