Sodium bicarbonate
Hyperosmolar solution. Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial
Indications: -Hyperkalemia -decr pain due to LA Toxicological indications- Cardiotoxicity secondary to fast sodium channel blockade-TCA,Bupropion,Chloroquine/hydroxychloroquine,Dextropropoxyphene,Propranolol. 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: Acute pulmonary oedema Hypokalaemia Metabolic or respiratory alkalosis Poorly controlled congestive cardiac failure Renal failure Severe hypernatraemia.
Adverse drug reactions: Alkalosis (serum pH >7.6 is detrimental to cardiovascular function) Hypernatraemia and hyperosmolarity Fluid overload and acute pulmonary oedema Hypokalaemia Local tissue inflammation secondary to extravasation
Administration: Cardiotoxicity secondary to fast sodium channel blockade: 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: Pregnancy: No restriction on use Lactation: No restriction on use Paediatric: Doses are the same as for adults on mmol/kg basis. Reduced fluid volumes should be used in children.