Sodium Bicarbonate 8.4%

Question 1

Sodium Bicarbonate 8.4% Indications

Answer 1

1. Cardiac arrest related to hyperkalaemia or tricyclic antidepressant (TCA) overdose or Propranolol overdose.
2. Life threatening toxic tricyclic antidepressant or Propranolol overdose

Question 2

Sodium Bicarbonate 8.4% exclusion criteria

Answer 2

Known hypersensitivity to sodium bicarbonate;

Hypothermic patients (core temperature <30°C).

Question 3

Sodium Bicarbonate 8.4% Cautions

Answer 3

Extravasation - tissue necrosis

Do not give Calcium Chloride solution and Sodium Bicarbonate 8.4% solution simultaneously by same route

Question 4

Sodium Bicarbonate side effects

Answer 4

• Alkalosis;
• Hypokalaemia;
• Hypernatremia;
• Hypocalcemia;
• Hyperosmolarity;
• Exacerbates intracellular acidosis;
• Produces a negative inotropic effect on ischaemic myocardium;
• Extravasation and tissue necrosis;
• Causes an increase in EtCO2 which must not be confused with ROSC

Question 5

Sodium Bicarbonate 8.4% Adult dose

Answer 5

Cardiac arrest due to hyperK: 50ml rapid bolus

Tricyclic antidepressant or Propranolol overdose with QRS 120-160ms: 50ml rapid bolus

Cardiac arrest due to TCA or propranolol overdose: 100ml rapid bolus

Question 6

Sodium Bicarbonate 8.4% repeat dose

Answer 6

For all indications the dose can be repeated once if there has been no response after 10 minutes.