Page 177 - 2023 SMOG Digital

SODIUM BICARBONATE Lactation Yes
Class / Mechanism of Action
Alkalinizing Agent; Antacid
Provides bicarbonate ion to neutralize hydrogen ion concentration and raise blood and urinary pH
Onset of action IV: 15 minutes, Duration 1-2 hours
Indications
Labeled Indications: Management of metabolic acidosis, hyperkalemia, overdose of certain drugs
(including tricyclic antidepressants and aspirin), and gastric hyperacidity.
Contraindications
• Alkalosis, hypernatremia, hypocalcemia
• severe pulmonary edema
• Unknown abdominal pain
Adverse Reactions / Precautions
• Use should be reserved for documented metabolic acidosis and for hyperkalemia induced 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
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
TriCyclic Antidepressant OD • Follow Adult Dosing
IV:
• 1mEq/kg; May repeat to maintain QRS <100
• Start Maintenance Infusion: 100-150mEq (2-3
amps) in 1 L D5 / NS @ 100-200mL/hr IV
Cardiac arrest (ACLS Guidelines, 2015):
IV:
• 1mEq/kg/dose; repeat doses should be
guided by arterial blood gases
Note: Routine use in cardiac arrest is not
recommended. Use may be considered in cases of
prolonged cardiac arrest once adequate alveolar
ventilation and effective cardiac compressions
have been established. In some cardiac arrest
situations (eg, metabolic acidosis, hyperkalemia, or
tricyclic antidepressant overdose), sodium
bicarbonate may be beneficial.
Hyperkalemia (ACLS Guidelines, 2015)
IV:
• 50mEq over 5 minutes
Metabolic acidosis:
If acid-base status is not available: 2-5mEq/kg
infusion over 4-8 hours

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