Sodium Bicarbonate 8.4%

Question 1

Generic Name:

Answer 1

Sodium Bicarbonate 8.4%

Question 2

Supplied:

Answer 2

50 mEq/50mL pre-filled syringe

Question 3

Mechanism of Action:

Answer 3

Buffers H+ and increases pH

Question 4

Indications and Field Use:

Answer 4

• Pre-existing metabolic acidosis
• Poisoning of aspirin, cyclic antidepressants (alkalization of the blood)
• Cardiac arrest after other interventions and ventilation is adequate

Question 5

Contraindications:

Answer 5

Alkalosis

Question 6

Adverse Reactions:

Answer 6

CV: Congestive heart failure, edema secondary to sodium overload.
Metabolic: Hyperosmolarity, metabolic alkalosis, hypernatremia, in cardiac arrest may cause extracellular alkalosis and intracellular acidosis

Question 7

Incompatibilities/Drug Interactions:

Answer 7

Incompatible with other drug infusions

Question 8

Adult Dosage:

Answer 8

Pre-exisiting Metabolic Acidosis or Alkalization of Blood: 50-100 mEq IV per medical control authority.

Infusion: 50 mEq of sodium bicarbonate/250 mL of NS or as determined by medical control

Cardiac Arrest: First dose usually 1 mEq/kg (or as determined by blood gas analysis), with subsequent doses of 0.5 mEq/kg every 10 minutes in cardiac arrest after other standard treatment (defib, CPR, intubation, ventilation and more than one trial of epi) has been used.

Question 9

Pediatric Dosage:

Answer 9

1 mEq/kg IV or IO slowly if ventilation is adequate according to medical control authority. Can contribute to acidosis and cause flu overload.

Question 10

Neonatal Dosage:

Answer 10

1 mEq/kg IV or IO of 4.2% slowly. Waste 25mL of 8.4% solution and add 25mL of NS from IV bag, each mL will contain 0.5 mEq of sodium bicarbonate.

Question 11

Routes of Administration:

Answer 11

IV bolus; IV infusion

For IV infusion to be monitored on interfacility transports, infusion pump is required.

Question 12

Onset of Action:

Answer 12

Seconds

Question 13

Peak Effects:

Answer 13

1-2 Minutes

Question 14

Duration of Action:

Answer 14

10 Minutes

Question 15

Arizona Drug Box Minimum Supply:

Answer 15

Optional: 100 mEq

Question 16

Special Notes:

Answer 16

• Flush tubing before and after admin, especially with concurrent use of calcium chloride
• Sodium Bicarb admin should be considered only for treatment of documented severe acidosis associated with prolonged cardiac arrest or an unstable hemodynamic state, hyperkalemia or certain poisonings (i.e. cycling antidepressants, ASA, phenobarbital, etc)
• In premature infants hyperosmolarity from undiluted sodium bicarb has been correlated w/ an increased risk of periventricular-intraventricular hemorrhage.
• Severe tissue necrosis will occur with extravasation.