SODIUM BICARBONATE - NaHCO3

CLASS: alkalinizing agent

ACTIONS:

• Binds with H+ ions to form Carbonic acid, which dissociates to water & carbon dioxide, & with CO2 excreted by the lungs decreases the acidity of the blood

• Cause potassium to shift into cells

INDICATIONS:

• Patients with known preexisting metabolic acidosis

• (DKA) IIa

• Hyperkalemia I

• Tricyclic anitdepressant overdose IIa

• Phenobarbital overdose

CONTRAINIDICATION:

• Metabolic and Respiratory Alkalosis

• Hypocalcemia

STANDARD PREP: 50 mEq/50 cc preloaded syringe

DOSAGE/ROUTE:

• 1 meq/kg IV

• 50 meq IV/IO for Renal Dialysis Code. If no change,

  repeat x1

• Follow ACLS Algorithm (TCA O.D.)

PEDS DOSE: PALS - 1 meq/kg

SIDE EFFECTS:

• Paradoxical intracellular/tissue acidosis due to CO2 generation & inadequate ventilations to rid CO2 which readily diffuses across cell membranes

• Hypernatremia from large sodium load

• Hyperosmolarity from large sodium load

• May shift oxyhemoglobin dissociation curve to the left which causes a decrease in the release of O2 by hgb to the tissues

• Metabolic alkalosis

PRECAUTIONS:

• Overly aggressive field use may result in metabolic alkalosis

• DO NOT MIX WITH CALCIUM CHLORIDE!

• Precipitates in line if not flushed well.

• Catecholamines tend to be deactivated in alkaline solutions like NaHCO3- Buffering action will produce CO2, so ventilation must be adequate