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-'...")
 
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Hyperosmolar solution.
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==Administration==
Presentation-50 mmol/50 mL pre-filled syringe,100 mmol/100 mL vial
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*Type: 8.4% is common cardiac administered per
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*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325 mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
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*Routes of Administration: IV
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*Common Trade Names: N/A
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{{Dosing Variables}}
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==Adult Dosing==
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===Cardiac Arrest===
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{{#var:bicarbmax}} mL (1 amp) IV push for severe acidemia and patient is adequately ventilated
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*Frequency<ref>eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749</ref>:
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**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
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**0.5 mEq/kg/dose q10min
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**OR tailor to serial ABGs
  
'''Indications:'''
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===IV drip===
-Hyperkalemia
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*150 mEq/1000 mL inD5W
-decr pain due to LA
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==Pediatric Dosing==
'''Toxicological indications-'''
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===Cardiac Arrest===
Cardiotoxicity secondary to fast sodium channel blockade-TCA,Bupropion,Chloroquine/hydroxychloroquine,Dextropropoxyphene,Propranolol.
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{{#var:bicarb}} mL/kg IV push for severe acidemia and patient is adequately ventilated
Prevent redistribution of drug to CNS-Severe salicylate poisoning.
 
Profound life-threatening metabolic acidosis-Cyanide,Toxic alcohol poisoning,Isoniazid overdose.
 
Enhance urinary drug elimination-Salicylate,Phenobarbitone intoxication.
 
Increase urinary solubility-Methotrexate toxicity.Drug-induced rhabdomyolysis
 
  
'''Contraindications:'''
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==Special Populations==
Acute pulmonary oedema
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*[[Drug Ratings in Pregnancy|Pregnancy Rating]]:
Hypokalaemia
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*[[Lactation risk categories|Lactation risk]]:
Metabolic or respiratory alkalosis
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===Renal Dosing===
Poorly controlled congestive cardiac failure
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*Adult:
Renal failure
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*Pediatric:
Severe hypernatraemia.
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===Hepatic Dosing===
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*Adult:
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*Pediatric:
  
'''Adverse drug reactions:'''
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==Contraindications==
Alkalosis (serum pH >7.6 is detrimental to cardiovascular function)
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*Allergy to class/drug
Hypernatraemia and hyperosmolarity
 
Fluid overload and acute pulmonary oedema
 
Hypokalaemia
 
Local tissue inflammation secondary to extravasation
 
  
'''Administration:'''
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==Adverse Reactions==
'''Cardiotoxicity secondary to fast sodium channel blockade:'''
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===Serious===
Resuscitation from severe cardiotoxicity (cardiac arrest, ventricular arrhythmias and hypotension)
 
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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===Common===
'''Pregnancy:''' No restriction on use
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'''Lactation:''' No restriction on use
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==Pharmacology==
'''Paediatric:''' Doses are the same as for adults on mmol/kg basis. Reduced fluid volumes should be used in children.
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*Half-life:  
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*Metabolism:  
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*Excretion:  
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==Mechanism of Action==
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==Comments==
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==See Also==
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==References==
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<references/>
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[[Category:Drugs]]

Revision as of 12:14, 15 February 2016

Administration

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


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

IV drip

  • 150 mEq/1000 mL inD5W

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

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:

Mechanism of Action

Comments

See Also

References