Sodium bicarbonate: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: 8.4% is common cardiac | *Type: 8.4% is common cardiac formulation | ||
*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; | **8.4% is 1 mEq/mL | ||
*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5% | |||
*Routes of Administration: IV | *Routes of Administration: IV | ||
*Common Trade Names: N/A | *Common Trade Names: N/A | ||
*Abbreviation: NaHOC3 | |||
{{Dosing Variables}} | {{Dosing Variables}} | ||
==Adult Dosing== | ==Adult Dosing== | ||
===Cardiac Arrest=== | ===Cardiac Arrest=== | ||
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**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult) | **1 mEq/kg IV bolus dose initially (~1-2 amps for average adult) | ||
**0.5 mEq/kg/dose q10min | **0.5 mEq/kg/dose q10min | ||
**OR tailor to serial ABGs | **'''OR''' tailor to serial ABGs | ||
===Severe Metabolic Acidemia (pH<7.1) === | |||
*IV drip | |||
**150 mEq/1000 mL inD5W | |||
**May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis <ref>Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.</ref> | |||
===Serum alkalinization (toxicology)=== | |||
*Enhance urinary elimination of salicylates, methotrexate and phenobarbital | |||
*Goal: serum pH of 7.5, urinary pH of 8.0 | |||
*Check K+ as well | |||
*IV drip | |||
**150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===Cardiac Arrest=== | ===Cardiac Arrest=== | ||
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==Special Populations== | ==Special Populations== | ||
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: | *[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C | ||
*[[Lactation risk categories|Lactation risk]]: | *[[Lactation risk categories|Lactation risk]]: Infant risk minimal | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: | *Adult: | ||
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==Contraindications== | ==Contraindications== | ||
*Allergy to class/drug | *Allergy to class/drug | ||
*Relative: | |||
**Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia) | |||
==Adverse Reactions== | ==Adverse Reactions== | ||
===Serious=== | ===Serious=== | ||
*Extravasation- cellulitis, tissue necrosis, ulcer | |||
*Metabolic alkalosis | |||
===Common=== | ===Common=== | ||
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==Comments== | ==Comments== | ||
*'''Sodium acetate''' can be used as a substitute for sodium bicarbonate during times of critical shortages<ref>Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.</ref> | |||
**Can be used to treat TCA and ASA toxicity | |||
**Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension | |||
==See Also== | ==See Also== | ||
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<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] | ||
[[Category:Critical Care]] |
Revision as of 22:23, 23 September 2019
Administration
- Type: 8.4% is common cardiac formulation
- 8.4% is 1 mEq/mL
- Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
- Routes of Administration: IV
- Common Trade Names: N/A
- Abbreviation: NaHOC3
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
Severe Metabolic Acidemia (pH<7.1)
- IV drip
- 150 mEq/1000 mL inD5W
- May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis [2]
Serum alkalinization (toxicology)
- Enhance urinary elimination of salicylates, methotrexate and phenobarbital
- Goal: serum pH of 7.5, urinary pH of 8.0
- Check K+ as well
- IV drip
- 150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour
Pediatric Dosing
Cardiac Arrest
1 mL/kg IV push for severe acidemia and patient is adequately ventilated
Special Populations
- Pregnancy Rating: C
- Lactation risk: Infant risk minimal
Renal Dosing
- Adult:
- Pediatric:
Hepatic Dosing
- Adult:
- Pediatric:
Contraindications
- Allergy to class/drug
- Relative:
- Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia)
Adverse Reactions
Serious
- Extravasation- cellulitis, tissue necrosis, ulcer
- Metabolic alkalosis
Common
Pharmacology
- Half-life:
- Metabolism:
- Excretion:
Mechanism of Action
Comments
- Sodium acetate can be used as a substitute for sodium bicarbonate during times of critical shortages[3]
- Can be used to treat TCA and ASA toxicity
- Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension
See Also
References
- ↑ eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749
- ↑ Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.
- ↑ Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.