sodium bicarbonate
Buffer
Sodium bicarbonate reacts with hydrogen ions to form water and carbon dioxide and thereby can act to buffer metabolic acidosis. By increasing the plasma concentration of bicarbonate, blood pH rises.
2-10 minutes
30-60 minutes
Known pre-existing bicarbonate responsive acidosis
Intubated patient with continued long arrest interval
Upon return of spontaneous circulation after long arrest interval
Tricyclic antidepressant overdose
Alkalinization for treament of specific intoxications.
In patients with chloride loss from vomiting and GI suction.
Metabolic and respiratory alkalosis
Hypocalcemia
Hypokalemia
Metabolic alkalosis
Hypoxia
Rise in intracellular PC02 and increased tissue acidosis
Electrolyte imbalance (tetany)
Seizures
Tissue sloughing at injection site
May precipitate in calcium solutions
May precipitate when given with catecholamines (epi, noreip, dopamine, dobutamine, etc)
Alkalinization of urine may increase half-lives of certain drugs
Vasopressors may be deactivated
50 mEq in 50 ml of solvent
IV: 1 mEq/kg, repeat with 0.5 mEq/kg every 10 minutes
Same as adult.
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 CHF