sodium bicarbonate (2023) (1).pdf

Paramedic Program Box 417 Lac La Biche, AB T0A 2C0 Generic Name: sodium bicarbonate Trade Name: Classification: alkalinizing agent Supplied: 8.4% preload (1 mEq/mL), 4.2% preload (0.5 mEq/mL) Actions (Pharmacodynamics):  Alkalinizing agent: is a systemic alkalizer, which increases plasma bicarbona...

Paramedic Program Box 417 Lac La Biche, AB T0A 2C0 Generic Name: sodium bicarbonate Trade Name: Classification: alkalinizing agent Supplied: 8.4% preload (1 mEq/mL), 4.2% preload (0.5 mEq/mL) Actions (Pharmacodynamics):  Alkalinizing agent: is a systemic alkalizer, which increases plasma bicarbonate, buffers excess hydrogen ion concentration, and raises blood pH, thereby reversing the clinical manifestations of acidosis. It also is a urine alkalizer, increasing the excretion of free bicarbonate ions in the urine, thus effectively raising the urinary pH. Indications:  Patients with documented preexisting metabolic acidosis i.e.; diabetic ketoacidosis  Overdoses associated with QRS > 0.12 seconds or ventricular tachycardia in tricyclic antidepressant, sympathomimetic, beta / calcium channel blocker, opioid  Known preexisting Hyperkalemia  Cardiac arrest in special situations; prolonged resuscitation, excited delirium  Rhabdomyolysis  ASA overdose (urine alkalization) Dosages: Adult/Pediatric Cardiac arrest in special situations/ Metabolic Acidosis / Overdoses (listed above) / Rhabdomyolysis / Urinary Alkalization / Hyperkalemia: 1.0 mEq/kg SIVP; repeat (prn) q 10 minutes at 0.5 mEq/kg to achieve hemodynamic stability and QRS narrowing TCA/ASA overdose: 1.0-2.0 mEq/kg SIVP; repeat (prn) q 10 minutes at 1.0 mEq/kg to achieve hemodynamic stability and QRS narrowing bolus then initiate infusion Infusion: 150mEq in a 1000ml D5W or NS = 0.15 mEq /ml - rate of 2-3 ml/kg/hour Adjustments of the IV are made based on blood pH and clinical response to the therapy. Contraindications:  Respiratory acidosis  Early in cardiac arrest (unless a specific reason to administer)  Respiratory and metabolic alkalosis  Hypocalcemia  Avoid extravasation due to risk of tissue irritation / necrosis Precautions:  May inactivate catecholamine’s in solution (i.e. epinephrine)  Flush well following administration, as it will cause precipitate if mixed with calcium salts (i.e. calcium chloride)  Complete correction of base deficit should be avoided  Is not recommended for routine use for patients in cardiac arrest; unless special resuscitation situation exist (see above for special resuscitation situations) Note:  Adequate ventilation and CPR, not bicarbonate, are the major buffer agents in cardiac arrest.  If rapidly available, use arterial blood gas analysis; during cardiac arrest ABG results are not reliable indicators of acidosis References: 4 (1169-1171), 8 (251), 9 (164-165, 700-702, 1208, 1215, 1292) © Portage College Paramedic Program Page 1 of 2 Revised: May 2023 © Portage College Paramedic Program Page 2 of 2