Difference between revisions of "Sodium bicarbonate"

(Reverted edits by Rossdonaldson1 (talk) to last revision by Neil.m.young)
(Adult Dosing)
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==Administration==
 
==Administration==
*Type: 8.4% is common cardiac administered per
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*Type: 8.4% is common cardiac formulation
 +
**8.4% is 1 mEq/mL
 
*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
 
*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
 
*Routes of Administration: IV
 
*Routes of Administration: IV
 
*Common Trade Names: N/A
 
*Common Trade Names: N/A
 +
*Abbreviation: NaHOC3
 
{{Dosing Variables}}
 
{{Dosing Variables}}
 +
 
==Adult Dosing==
 
==Adult Dosing==
 
===Cardiac Arrest===
 
===Cardiac Arrest===
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**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
 
**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
 
**0.5 mEq/kg/dose q10min
 
**0.5 mEq/kg/dose q10min
**OR tailor to serial ABGs
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**'''OR''' tailor to serial ABGs
 +
 
 +
===Severe Metabolic Acidemia (pH<7.1) ===
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*IV drip
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**150 mEq/1000 mL inD5W
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**May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis <ref>Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.</ref>
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===Serum alkalinization (toxicology)===
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*Enhance urinary elimination of salicylates, methotrexate and phenobarbital
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*Goal: serum pH of 7.5, urinary pH of 8.0
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*Check K+ as well
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*IV drip
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**150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour
  
===IV drip===
 
*150 mEq/1000 mL inD5W
 
 
==Pediatric Dosing==
 
==Pediatric Dosing==
 
===Cardiac Arrest===
 
===Cardiac Arrest===
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==Comments==
 
==Comments==
 +
*'''Sodium acetate''' can be used as a substitute for sodium bicarbonate during times of critical shortages<ref>Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.</ref>
 +
**Can be used to treat TCA and ASA toxicity
 +
**Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension
  
 
==See Also==
 
==See Also==

Revision as of 16:26, 31 August 2019

Administration

  • Type: 8.4% is common cardiac formulation
    • 8.4% is 1 mEq/mL
  • Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
  • Routes of Administration: IV
  • Common Trade Names: N/A
  • Abbreviation: NaHOC3



Adult Dosing

Cardiac Arrest

50 mL (1 amp) IV push for severe acidemia and patient is adequately ventilated

  • Frequency[1]:
    • 1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
    • 0.5 mEq/kg/dose q10min
    • OR tailor to serial ABGs

Severe Metabolic Acidemia (pH<7.1)

  • IV drip
    • 150 mEq/1000 mL inD5W
    • May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis [2]

Serum alkalinization (toxicology)

  • Enhance urinary elimination of salicylates, methotrexate and phenobarbital
  • Goal: serum pH of 7.5, urinary pH of 8.0
  • Check K+ as well
  • IV drip
    • 150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour

Pediatric Dosing

Cardiac Arrest

1 mL/kg IV push for severe acidemia and patient is adequately ventilated

Special Populations

Renal Dosing

  • Adult:
  • Pediatric:

Hepatic Dosing

  • Adult:
  • Pediatric:

Contraindications

  • Allergy to class/drug
  • Relative:
    • Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia)

Adverse Reactions

Serious

  • Extravasation- cellulitis, tissue necrosis, ulcer
  • Metabolic alkalosis

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:

Mechanism of Action

Comments

  • Sodium acetate can be used as a substitute for sodium bicarbonate during times of critical shortages[3]
    • Can be used to treat TCA and ASA toxicity
    • Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension

See Also

References

  1. eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749
  2. Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.
  3. Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.