• Sodium Bicarbonate (NaHCO3)

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    Sodium Bicarbonate (NaHCO3)

    Class
    Buffer, alkalinizing agent


    Description
    Sodium bicarbonate reacts with hydrogen 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
    1. Metabolic acidosis
    2. Known preexisting bicarbonate-responsive acidosis
    3. Intubated patient with continued long arrest interval
    4. Upon return of spontaneous circulation after long arrest interval
    5. Tricyclic antidepressant overdoses
    6. Alkalinization for treatment of specific intoxications
    7. Hyperkalemia


    Contraindications
    1. In patients with chloride loss from vomiting and GI suction
    2. Metabolic and respiratory alkalosis
    3. Hypocalcemia
    4. Hypokalemia


    Adverse Reactions
    1. Metabolic alkalosis
    2. Hypoxia
    3. Rise in intracellular PCO2 and increased tissue
    acidosis
    4. Electrolyte imbalance (tetany)
    5. Seizures
    6. Tissue sloughing at injection site
    7. Fluid overload
    8. Hypokalemia


    Drug Interactions
    1. May precipitate in calcium solutions
    2. Alkalinization of urine may increase half-lives of certain drugs
    3. Vasopressors may be deactivated.


    Special Considerations
    1. Pregnancy safety: Category C
    2. When possible, blood gas analysis should guide bicarbonate administration.
    3. Bicarbonate administration produces carbon dioxide, which crosses cell membranes more rapidly than bicarbonate, potentially worsening intracellular acidosis.
    4. May increase edematous or sodium-retaining states.
    5. May worsen congestive heart failure.
    6. In line precipitation when mixed with epinephrine, must flush lines adequately before and after administration.
    Categories:
    1. Meds N thru Z
    Tags :
    Comments 8 Comments
    1. screaming pizza's Avatar
      Carry your protocol book into the ER if you have standing orders to give this in TCA ODs. Otherwise, docs freak and PGYs crap their pants when they find out you gave it without asking.
      Reply
    1. medic pathetic's Avatar
      Docs just may surprise you though. The docs at a local ER were really excited and wanted to compare ECGs and 12 leads from before and after my administration. All we have are standing orders. :-)
      Reply
    1. jozak78's Avatar
      BiCarb the miracle drug. a little off topic, but my fav use i've ever seen for the stuff was nebulized for a chlorine inhalation.
      Reply
    1. medic pathetic's Avatar
      Quote Originally Posted by jozak78
      BiCarb the miracle drug. a little off topic, but my fav use i've ever seen for the stuff was nebulized for a chlorine inhalation.
      Oh really? Interesting! Care to elaborate some time?
      Reply
    1. Mogollon's Avatar
      While there exist several case studies that attribute inhaled sodium bicarbonate to improving patient condition, the literature ( clinical trials ) is lacking and not able to definitively back up this assumption.

      In theory, inhaled sodium bicarbonate works like this:

      First: biological injury from chlorine is theorised to be caused by acids produced when chlorine comes into contact with water in tissue pulmonary and newer thoughts that in fact REDOX reactions during this reaction destroy functional cellular groups. Another thought that is controversial still exists that oxygen free radicals produced during these reactions also cause cellular damage. The exact mechanisms are not well understood. The basic chemistry of the acid formation roughly look like this:

      Cl2 + H2O -----> HCl & HOCL

      HCl is hydrochloric acid and HOCl is hydrochlorous acid.

      Clearly, a base such as bicarbonate may help; however, with all the unknowns it is not known if it really does help. In addition, bicarbonate would have to be given early on in the treatment process. With that. it is theoretically possible that the bicarbonate could actually cause more damage as the reaction with these acids is exothermic (produces heat).
      Reply
    1. medic pathetic's Avatar
      Chlorine as in near drowning in a pool, or chlorine as in aspiration of pool cleaner?
      Reply
    1. Mogollon's Avatar
      Most likely, exposure to chlorine gas in most cases. Cl2 indicates two chlorine atoms covalently bound to one and other in a non-polar molecule. This can occur with some types of pool cleaners, typically large pubic pools utilise the chlorine cleaners. Often, other chemicals such as bromine are utilised. In some cases, you may hear the term chlorine bleach. Bleach is actually called sodium hypochlorite [Na+][OCl-]. Typically, house hold bleach is fairly safe; however, mixing with other compounds can liberate chlorine gas and lead to chlorine inhalation.
      Reply
    1. medic pathetic's Avatar
      Ah, household bleach and ammonia. That makes a lot of sense. :-)
      Reply

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