Difference between revisions of "Sodium bicarbonate"

(Created page with "Hyperosmolar solution. Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial '''Indications:''' -Hyperkalemia -decr pain due to LA '''Toxicological indications-'...")
 
(Adult Dosing)
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Hyperosmolar solution.
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==Administration==
Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial
+
*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
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*Common Trade Names: N/A
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*Abbreviation: NaHOC3
 +
{{Dosing Variables}}
  
'''Indications:'''
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==Adult Dosing==
-Hyperkalemia
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===Cardiac Arrest===
-decr pain due to LA
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{{#var:bicarbmax}} mL (1 amp) IV push for severe acidemia and patient is adequately ventilated
'''Toxicological indications-'''
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*Frequency<ref>eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749</ref>:
Cardiotoxicity secondary to fast sodium channel blockade-TCA,Bupropion,Chloroquine/hydroxychloroquine,Dextropropoxyphene,Propranolol.
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**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
Prevent redistribution of drug to CNS-Severe salicylate poisoning.
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**0.5 mEq/kg/dose q10min
Profound life-threatening metabolic acidosis-Cyanide,Toxic alcohol poisoning,Isoniazid overdose.
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**'''OR''' tailor to serial ABGs
Enhance urinary drug elimination-Salicylate,Phenobarbitone intoxication.
 
Increase urinary solubility-Methotrexate toxicity.Drug-induced rhabdomyolysis
 
  
'''Contraindications:'''
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===Severe Metabolic Acidemia (pH<7.1) ===
Acute pulmonary oedema
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*IV drip
Hypokalaemia
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**150 mEq/1000 mL inD5W
Metabolic or respiratory alkalosis
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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>
Poorly controlled congestive cardiac failure
 
Renal failure
 
Severe hypernatraemia.
 
  
'''Adverse drug reactions:'''
+
===Serum alkalinization (toxicology)===
Alkalosis (serum pH >7.6 is detrimental to cardiovascular function)
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*Enhance urinary elimination of salicylates, methotrexate and phenobarbital
Hypernatraemia and hyperosmolarity
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*Goal: serum pH of 7.5, urinary pH of 8.0
Fluid overload and acute pulmonary oedema
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*Check K+ as well
Hypokalaemia
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*IV drip
Local tissue inflammation secondary to extravasation
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**150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour
  
'''Administration:'''
+
==Pediatric Dosing==
'''Cardiotoxicity secondary to fast sodium channel blockade:'''
+
===Cardiac Arrest===
Resuscitation from severe cardiotoxicity (cardiac arrest, ventricular arrhythmias and hypotension)
+
{{#var:bicarb}} mL/kg IV push for severe acidemia and patient is adequately ventilated
Give repeated boluses of 2 mmol/kg IV until cardiovascular stability is achieved
 
'''Maintenance of serum alkalinisation in severe cardiotoxicity:'''
 
Consider following resuscitation in the presence of ventricular arrhythmias, hypotension, or a markedly wide QRS complex (>140 ms)
 
Commence an infusion of 100 mmol sodium bicarbonate diluted in 1000 mL normal saline at 250 mL/hour
 
Hourly ABGs and maintain serum pH 7.50–7.55
 
Cease following resolution of cardiovascular toxicity as determined by clinical and ECG criteria
 
'''Prevention of redistribution of salicylate to CNS:'''
 
Maintain pH above 7.4 at all times
 
Intubated pt-serum pH may be maintained >7.4 by hyperventilation
 
Unwell un-intubated patient with salicylate poisoning-Give sodium bicarbonate 2 mmol/kg IV bolus,Then intubate, hyperventilate and recheck ABGs.
 
Serum alkalinisation is maintained until definitive care with haemodialysis.
 
'''Urinary alkalinisation:'''
 
Correct hypokalaemia if present.Give 1–2 mmol/kg sodium bicarbonate IV bolus
 
Commence infusion of 100 mmol sodium bicarbonate in 1000 mL 5% dextrose at 250 mL/hour
 
20 mmol of KCl may be added to infusion to maintain normokalaemia
 
Monitor serum bicarbonate and potassium at least every 4 hours
 
Regularly dipstick urine and aim for urinary pH >7.5 .Continue until resolving clinical and laboratory evidence of toxicity.
 
  
'''Specific considerations:'''
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==Special Populations==
'''Pregnancy:''' No restriction on use
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*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
'''Lactation:''' No restriction on use
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*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
'''Paediatric:''' Doses are the same as for adults on mmol/kg basis. Reduced fluid volumes should be used in children.
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===Renal Dosing===
 +
*Adult:
 +
*Pediatric:
 +
===Hepatic Dosing===
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*Adult:
 +
*Pediatric:
 +
 
 +
==Contraindications==
 +
*Allergy to class/drug
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*Relative:
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**Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia)
 +
 
 +
==Adverse Reactions==
 +
===Serious===
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*Extravasation- cellulitis, tissue necrosis, ulcer
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*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<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==
 +
 
 +
==References==
 +
<references/>
 +
[[Category:Pharmacology]]

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.