Sodium Bicarbonate
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 form 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.
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