Classes
DEA Class; OTC
Common Brand Names;
- Alkalinizing Agents
Description
Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH
Indications
Indicated for
- Cardiac Arrest
- Hyperkalemia
- Metabolic Acidosis
Contraindications
Hypersensitivity
Injection
- Chloride loss due to vomiting or from continuous gastrointestinal suction
- Currently treated with diuretics
Adverse Effects
- Aggravated CHF
- Cerebral hemorrhage
- Edema
- Hypernatremia
- Hypocalcemia
- Hypokalemia
- Tetany
- Metabolic alkalosis
- Belching
- Gastric distension
- Pulmonary edema
- Hypernatremia
- Hyperosmolality
- Intracranial acidosis
- Milk-alkali syndrome
Warnings
Not first-line for resuscitation
Use with caution in patients with congestive heart failure, severe renal insufficiency, edematous or sodium-retaining states, HTN, children with DKA, and concurrent corticosteroid use
IV administration can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema
Avoid extravasation (may cause chemical cellulitis, tissue necrosis, ulceration & sloughing due to alkalinity)
Potassium depletion may predispose to metabolic alkalosis and coexistent hypocalcemia may be associated with carpopedal spasm as plasma pH rises; treat appropriately before or during the infusion to minimize the risk of such electrolyte imbalance
Pregnancy and Lactation
Pregnancy
Unknown if fetal harm may occur when administered to pregnant females or can affect reproduction capacity
Use if clearly needed
Lactation
Unknown if excreted in breast milk
Maximum Dosage
Adult
cardiac Arrest
Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit
Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established
Hyperkalemia
50 mEq IV over 5 minutes
Metabolic Acidosis
Non-life-threatening: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH
Severe (except hypercarbic acidosis): 90-180 mEq/L (~7.5-15 g) at a rate of 1-1.5 L (first hour); adjust for further management as needed
Pediatric
Cardiac Arrest
Infants, <2 years (use 4.2% solution)
- Initial: 1 mEq/kg/min given over 1-2 minutes IV/IO, THEN
- 1 mEq/kg IV q10min of arrest
- Not to exceed 8 mEq/kg/day
≥2 years
- Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit
- Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established
Metabolic Acidosis (Non-Life-Threatening)
Older children: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH
0.25-2mEq/kg IV infusion can be considered for acidosis with a pH <7.0-7.2
How supplied
Sodium bicarbonate
injectable solution
- 4%
- 4.2%
- 7.5%
- 8.4%
tablet
- 325mg
- 650mg
