Sodium Bicarbonate

Sodium Bicarbonate

[10ml 8.4% $11.30]

ADMINISTRATION ROUTES:

• IV

ALTERNATIVE NAMES:

• Sodium Bicarbonate

ICU INDICATIONS:

1. Correction of normal anion gap acidosis
2. Correction of severe metabolic acidosis associated with myocardial dysfunction where acidosis may be contributory to myocardial dysfunction
3. Toxicological indications:
   (i) cardiotoxicity secondary to fast sodium channel blockers:
   - tricyclics
   - bupropion
   - venlafaxine
   - dextropropoxyphene
   - propranolol
   - type 1a and 1c antiarrhythmics (flecainide, quinidine and quinine)
   (ii) prevention of restribution of drug to the CNS: severe salicylate poisoning
   (iii) immediate correction of profound life-threatening metabolic acidosis:
   - cyanide poisoning
   - isoniazid poisoning
   - toxic alcohol poisoning (ethylene glycol, methanol & other toxic alcohols)
   (iv) enhanced urinary drug elimination
   - salicylate intoxication (any symptomatic patient)
   - phenobarbitone intoxication (any symptomatic patient)
   (v) increased urinary solubility
   - methotrexate toxicity
   - drug induced rhabdomyolysis

PRESENTATION AND ADMINISTRATION:

• IV:
  8.4% (1mmol/ml) 10ml ampoule and 8.4% 50 & 100ml glass bottles
  Store at room temperature
  Compatible with the following IV fluids: 0.9% sodium chloride, 5% glucose, glucose and sodium chloride
  Do not use solutions which are cloudy or have visible precipitate
  Administer via a central line if possible (i.e. if a central line is present this is the preferred route)
  In ICU, it is usual to administer sodium bicarbonate undiluted over an hour; in an emergency situation it can be administered undiluted by direct IV injection.

DOSAGE:

• IV:
  Usual dose 1mmol/kg IV (repeated as required)
  Alternative method to calculate dose is: Dose (mmol) = Base Excess x Weight/10 (these doses correct half the base deficit)
  In severe cardiotoxicity due to fast sodium channel blockade in drug overdose give 2mmol/kg IV and repeat until cardiovascular stability is achieved

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

• Dose in renal impairment [GFR (ml/min)]:
  <10: use with caution
  10-20: use with caution
  >20-50: dose as in normal renal function
• Dose in renal replacement therapy:
  CAPD: use with caution
  HD: use with caution
  CVVHDF: dose as in normal renal function

DOSAGE IN PAEDIATRICS:

• If Patient Weight < 5kg:
  Dose (mmol) = Base Excess x Weight/4
• If Patient Weight > 5kg:
  Dose (mmol) = Base Excess x Weight/6

CLINICAL PHARMACOLOGY:

• Sodium bicarbonate

CONTRAINDICATIONS

1. severe hypernatraemia
2. alkalosis
3. hypokalaemia

WARNINGS

• Fluid overload:
  Sodium bicarbonate constitutes a significant sodium load and may precipitate fluid overload. Patients with poorly controlled congestive cardiac failure, renal failure and acute pulmonary oedema are at particular risk.

PRECAUTIONS

• General: Alkalosis may precipitate hypokalaemia
• Laboratory Tests: No tests in addition to routine ICU tests are required.
• Drug/Laboratory Test Interactions: None noted.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

• None

ADVERSE REACTIONS

• Cardiovascular System: Fluid overload, Acute pulmonary oedema
• Respiratory System: Respiratory depression, hypoxia (secondary to compensatory respiratory acidosis)
• Metabolic System: Alkalosis, hypernatraemia, hypokalaemia, hypocalcaemia, hyperosmolarity
• Local: Local tissue inflammation secondary to extravasation