SODIUM BICARBONATE - Summa Center for EMS

SODIUM BICARBONATE
CLASSIFICATION
TRADE NAME(S)
DESIRED EFFECTS
MECHANISM OF ACTION
Alkalinizing agent
None
Treats and prevents arrhythmias in tricyclic overdoses;
rapidly drops potassium levels in serious cases of
hyperkalemia especially in dialysis and renal failure
patients; improves coronary perfusion when given with
epinephrine.
Acts as a source of bicarbonate ions; increases pH
(alkalization) in blood and urine; acts as a buffering
(neutralizing) agent for acids in the blood and interstitial
fluid.
INDICATIONS • Metabolic acidosis
• Prolonged resuscitation efforts
• Tricyclic antidepressant overdose
• Hyperkalemia
CONTRAINDICATIONS • Congestive heart failure
• Metabolic or respiratory alkalosis
• Hypokalemia
• Hypocalcemia
ADVERSE REACTIONS • Hypoxia
• Paradoxical CNS acidosis
• Metabolic alkalosis
• Hypernatremia
• Seizures
• May slough tissue at injection site (cytotoxic)
DRUG INTERACTIONS • May precipitate when given with atropine,
calcium chloride, morphine aminophylline, and
magnesium.
• Epinephrine, dopamine, and isopreterenol are
inactivated when given with sodium bicarbonate
PRECAUTIONS • Be sure to have good flow in IV prior to giving
slowly
• May worsen CHF
SPECIAL CONSIDERATIONS
Adequate ventilation is the mainstay of acid-base balance
in cardiac arrest. Sodium bicarbonate is reserved for
patients with severe acidosis, or empirically for prolonged
resuscitation efforts after ventilation, oxygenation, and
perfusion has been established.
Effective 7/1/11 Drug Index Sodium Bicarbonate

SODIUM BICARBONATE
DOSING REGIMEN • Adult –
o Full Arrest (Special Considerations) –
1 mEq/kg IV push.
o
o
Renal Emergencies – 50 mEq IVP
Crush Injury – 1 mEq/kg IVP the add
50 mEq to each 1000 ml of NS wide
open; additional 1 mEq/kg IVP just
before extrication
PROTOCOL LOCATION • Cardiac Arrest
• Renal Emergencies
• Trauma Emergencies - Crush
Effective 7/1/11 Drug Index Sodium Bicarbonate