Class: Buffer

Description

Sodium bicarbonate reacts with hydrogen ions to form water and carbon dioxide and thereby can act to buffer metabolic acidosis. Increasing the plasma concentration of bicarbonate causes blood pH to rise.

Onset & Duration

Onset: 2-10 min

Duration: 30-60 min

Indications

Known preexisting bicarbonate-responsive acidosis

Intubated patient with continued long arrest interval

Upon return of spontaneous circulation after long arrest interval

Tricyclic antidepressant overdose

Alkalinization for treatment of specific intoxications

Contraindications

In patients with chloride loss from vomiting and Gl suction

Metabolic and respiratory alkalosis

Hypocalcemia Hypokalemia

Adverse Reactions

Metabolic alkalosis Hypoxia

Rise in intracellular Pco2 and increased tissue acidosis

Electrolyte imbalance (tetany)

Seizures Tissue slougthing at injection site

Drug Interactions

May precipitate in calcium solutions.

Alkalinization of urine may increase half-lives of certain drugs.

Vasopressors may be deactivated.

How Supplied

50 mEq in 50 ml of solvent

Dosage and Administration

Urgent forms of metakolic acidosis

Adult: 1 mEq/kg IV; repeat with 0.5 mEq/kg q 10 min

Pediatric: Same as adult

Special Considerations

Pregnancy safety: Category C.

When possible, blood gas analysis should guide bicarbonate administration.

Bicarbonate administration produces carbon dioxide, which crosses cell membranes more rapidly than bicarbonate, potentially worsening intracellular acidosis.

May increase edematous or sodium-retaining states.

May worsen congestive heart failure.