Page 173 - 2026 SMOG

SODIUM BICARBONATE
Class/Mechanism of Action
• Alkalinizing Agent; Antacid
Provides bicarbonate ions to neutralize the hydrogen ion concentration and raise the blood and
urinary pH.
˚ Onset of action—IV: 15min; Duration—PO: 1–3hr, IV: 15min
Indications
• Labeled Indications
˚ Management of metabolic acidosis, hyperkalemia, overdose of certain drugs (including
tricyclic antidepressants and aspirin), and gastric hyperacidity
Contraindications
• Chloride loss due to vomiting or from continuous GI suction; concomitant use of diuretics
known to produce hypochloremic alkalosis
• Alkalosis, hypernatremia, hypocalcemia
Adverse Reactions/Precautions
• Use should be reserved for documented severe metabolic acidosis and for severe/emergent
hyperkalemia (e.g., cardiotoxicity or cardiac arrest). Routine use in cardiac arrest is not
recommended.
• Avoid extravasation; tissue necrosis can occur.
• Can cause hypernatremia, hypocalcemia, hypokalemia, intracranial acidosis, metabolic
alkalosis
• Use caution in patients with edema, heart failure, cirrhosis, and kidney impairment.
• Lactation: Safe
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Tricyclic Antidepressant Overdose Hyperkalemia with Widen QRS/Severe
• IV Metabolic Acidosis (Prolonged Cardiac
˚ 1–2mEq/kg; May repeat to maintain Arrest/Resuscitation)
QRS <100
• IV/IO
˚ Start Maintenance Infusion: 100–150mEq ˚ 1mEq/kg; given slowly
(2–3 amps) in 1L D5/NS at 100–200mL/hr
Cardiac Arrest Tricyclic Antidepressant/Sodium Channel
Blocker Overdose
• IV • IV
˚ 1mEq/kg/dose; arterial blood gases ˚ Titrate to maintain a serum PH of 7.45 to
should guide repeat doses
maintain metabolic alkalosis
Note: Routine use in cardiac arrest is not 7.55; follow with a 150mEq/L infusion to
recommended. Use may be considered Note: Use 0.5mEQ/mL (4.2%) concentration
in cases of prolonged cardiac arrest once only for infants <1 month or dilute available
adequate alveolar ventilation and effective stock to this concentration
cardiac compressions have been established.
In some cardiac arrest situations (e.g.,
metabolic acidosis, hyperkalemia, or tricyclic
antidepressant overdose), sodium bicarbonate
may be beneficial.
2026 Standard Medical Operating Guidelines (SMOG) • 165