Sodium Bicarbonate
Liverpool Hospital Emergency Department
Indications:
- Sodium Channel Blocker overdose with QRS widening and CNS depression
- TCA / Bupropion / Chloroquine / Local Anaesthetics / Propranolol / Class 1 antiarrhythmics e.g. flecainide quinidine quinine
- Urinary Alkalinisation in Salicylate overdose & Chlorophenoxy Herbicide Poisoning
- It can be considered in the treatment of severe metabolic acidosis as a bridging therapy pending haemodialysis
- severe acidosis with poor response to inotropy (to increase inotrope effectiveness – generally pH <7)
- Severe acidosis prior to induction as a buffer during predicted risk of worsening acidosis
- Hyperkalaemia (e.g. potassium overdose / digoxin overdose
Formulation:
- 8.4% 100ml bottle 1mmol/ml
Dosage and Administration
- TCA poisoning prior to the induction of anaesthesia
- 1-2mmol/kg as single bolus dose prior to institution of hyperventilation
- Sodium Channel blocker overdose with QRS widening
- 1-2mmol/kg as bolus prior to institution of hyperventilation
Max dose in boluses 6mmol/kg
- Urinary alkalinisation
- 1mmol/kg bolus followed by an infusion
- Infusion 150mmol (150ml NaHCO3 + 850ml 5% Dextrose) 166ml/hr aiming for urinary pH >7.5 (do not exceed a serum pH of 7.5)
- Maintain normokalaemia
- Hyperkalaemia:
- 50ml bolus over 5-10 minutes repeat after 15 minutes
Side Effects:
- Pulmonary oedema
- Hypokalaemia
- Metabolic or respiratory alkalosis
- Hypernatraemia
- Renal failure
- Extravasation and phlebitis
Pit Falls
- This is a temporising measure until hyperventilation can be performed aiming for a pH 7.45-7.55 in the case of sodium channel blocker overdose
- Do not give repeated doses of NaHCO3 unless there is a clear QRS response o Avoid pH >7.55
- Avoid hypernatraemia