8.4% sodium bicarbonate

Question 1

Indications:

Answer 1

• Release syndrome following crush injury in an adult.
• A Known or suspected hyperkalaemia with severe
  ECG changes.

A Cardiac arrest secondary to hyperkalaemia.

A Suspected cyclic antidepressant poisoning with
QRS prolongation.

A Severe TBI and intubated with clinical signs of
raised intracranial pressure.

Question 2

Contraindications and cautions

Answer 2

Contraindications:
A Known severe allergy.

Cautions:
A IV access via a small vein. 8.4% sodium bicarbonate is hyperosmolar and will cause venous irritation if administered via a small vein.

Question 3

Action:

Answer 3

8.4% sodium bicarbonate is a
systemic alkalinising agent. It
increases plasma bicarbonate,
buffers hydrogen ions and raises
the blood pH.

Following crush injury 8.4%
sodium bicarbonate has a role
because:
- Sodium ions help protect cardiac cell membranes
from the effects of hyperkalaemia.

-A rise in pH results in potassium moving into the
cells, which lowers the potassium concentration in
blood.

• A rise in urinary pH reduces myoglobin deposition in the kidneys.

Question 4

Route

Answer 4

• IV (Large vein)
• running line
• over 1 minute
• do not mix with calcium (precipitation)

Question 5

Dosage:

Answer 5

100ml for adult
2ml/kg child

can repeat for hyperkalaemia in 20 minutes or 10 minutes if cardiac arrest