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

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