Sodium bicarbonate: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: 8.4% is common cardiac | *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% | *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 | ||
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==Adult Dosing== | ==Adult Dosing== | ||
===Cardiac Arrest=== | ===[[Cardiac Arrest]]=== | ||
{{#var:bicarbmax}} mL (1 amp) IV push for severe acidemia and patient is adequately ventilated | {{#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>: | *Frequency<ref>eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749</ref>: | ||
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**'''OR''' tailor to serial ABGs | **'''OR''' tailor to serial ABGs | ||
=== | ===Severe [[Metabolic Acidemia]] (pH<7.1) === | ||
*150 mEq/1000 mL inD5W | *IV drip | ||
**150 mEq/1000 mL inD5W | |||
**May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis (although this study used 4.2% sodium bicarbonate, a product not widely available within the United States)<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]]=== | ||
{{#var:bicarb}} mL/kg IV push for severe acidemia and patient is adequately ventilated | *{{#var:bicarb}} mL/kg IV push for severe acidemia and patient is adequately ventilated | ||
*Sodium bicarbonate administration in cardiac arrest has not been shown to improve survival to discharge<ref>Dybvik T, Strand T, Steen PA. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 1995 Apr;29(2):89-95. doi: 10.1016/0300-9572(95)00850-s. PMID: 7659873.</ref><ref>Vukmir RB, Katz L; Sodium Bicarbonate Study Group. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006 Mar;24(2):156-61. doi: 10.1016/j.ajem.2005.08.016. PMID: 16490643.</ref> | |||
*ACLS guidelines recommend against routine use of sodium bicarbonate in cardiac arrest although there may be benefit in the setting of [[hyperkalemia]] or [[Tricyclic antidepressant toxicity|tricyclic antidepressant]] overdose | |||
==Special Populations== | ==Special Populations== | ||
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*Extravasation- cellulitis, tissue necrosis, ulcer | *Extravasation- cellulitis, tissue necrosis, ulcer | ||
*Metabolic alkalosis | *Metabolic alkalosis | ||
*Hypernatremia <ref>Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, Hargarten KM, Thompson B. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992 Jan;10(1):4-7. doi: 10.1016/0735-6757(92)90115-e. PMID: 1736913.</ref> | |||
===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 10:46, 12 December 2020
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 (although this study used 4.2% sodium bicarbonate, a product not widely available within the United States)[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
- Sodium bicarbonate administration in cardiac arrest has not been shown to improve survival to discharge[3][4]
- ACLS guidelines recommend against routine use of sodium bicarbonate in cardiac arrest although there may be benefit in the setting of hyperkalemia or tricyclic antidepressant overdose
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
- Hypernatremia [5]
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[6]
- 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.
- ↑ Dybvik T, Strand T, Steen PA. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 1995 Apr;29(2):89-95. doi: 10.1016/0300-9572(95)00850-s. PMID: 7659873.
- ↑ Vukmir RB, Katz L; Sodium Bicarbonate Study Group. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006 Mar;24(2):156-61. doi: 10.1016/j.ajem.2005.08.016. PMID: 16490643.
- ↑ Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, Hargarten KM, Thompson B. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992 Jan;10(1):4-7. doi: 10.1016/0735-6757(92)90115-e. PMID: 1736913.
- ↑ 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.