SODIUM BICARBONATE
CLASSIFICATION
Alkalinizing agent
TRADE NAME(S)
None
DESIRED EFFECTS
Treats and prevents arrhythmias in tricyclic overdoses;
rapidly drops potassium levels in serious cases of
hyperkalemia especially in dialysis and renal failure
patients; improves coronary perfusion when given with
epinephrine.
MECHANISM OF ACTION
Acts as a source of bicarbonate ions; increases pH
(alkalization) in blood and urine; acts as a buffering
(neutralizing) agent for acids in the blood and interstitial
fluid.
INDICATIONS
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Metabolic acidosis
Prolonged resuscitation efforts
Tricyclic antidepressant overdose
Hyperkalemia
CONTRAINDICATIONS
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Congestive heart failure
Metabolic or respiratory alkalosis
Hypokalemia
Hypocalcemia
ADVERSE REACTIONS
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Hypoxia
Paradoxical CNS acidosis
Metabolic alkalosis
Hypernatremia
Seizures
May slough tissue at injection site (cytotoxic)
DRUG INTERACTIONS
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May precipitate when given with atropine,
calcium chloride, morphine aminophylline, and
magnesium.
Epinephrine, dopamine, and isopreterenol are
inactivated when given with sodium bicarbonate
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PRECAUTIONS
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SPECIAL CONSIDERATIONS
Effective 7/1/11
Be sure to have good flow in IV prior to giving
slowly
May worsen CHF
Adequate ventilation is the mainstay of acid-base balance
in cardiac arrest. Sodium bicarbonate is reserved for
patients with severe acidosis, or empirically for prolonged
resuscitation efforts after ventilation, oxygenation, and
perfusion has been established.
Drug Index
Sodium Bicarbonate
SODIUM BICARBONATE
DOSING REGIMEN
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Adult –
o Full Arrest (Special Considerations) –
1 mEq/kg IV push.
o Renal Emergencies – 50 mEq IVP
o Crush Injury – 1 mEq/kg IVP the add
50 mEq to each 1000 ml of NS wide
open; additional 1 mEq/kg IVP just
before extrication
PROTOCOL LOCATION
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Cardiac Arrest
Renal Emergencies
Trauma Emergencies - Crush
Effective 7/1/11
Drug Index
Sodium Bicarbonate