Sodium Bicarbonate

Aliases: Baking Soda

Indications: Hyperkalemia, Tricyclic or Sodium Channel Blocker Overdose, Crush Syndrome          

Contraindications: 

Concentrations: 

Injection:

Dosing

Adult:

Indication	Dose	Route	Note
Hyperkalemia	1 mEq/kg (Max: 50mEq)	IV Push	Give once
TCA/Sodium Channel Blocker Overdose	1 mEq/kg (Max: 50mEq)	IV Push	Repeat every 1-2 minutes PRN until QRS narrows
Crush Syndrome	1 mEq/kg (Max: 50mEq)	IV Push	Give once prior to releasing the body part.

Pediatric:

Indication	Dose	Route	Note
Hyperkalemia	1 mEq/kg (Max: 50mEq)	IV Push	Give once
TCA/Sodium Channel Blocker Overdose	1 mEq/kg (Max: 50mEq)	IV Push	Repeat every 1-2 minutes PRN until QRS narrows
Crush Syndrome	1 mEq/kg (Max: 50mEq)	IV Push	Give once prior to releasing the body part.

Precautions:      

Adverse/Side Effects: Alkalosis, Hyperirritability, Seizures, Tetany (electrolyte imbalance), Cardiac & respiratory arrest. Lowering of serum potassium, Decreased fibrillation threshold. 

Class: Alkalinizing Agent 

Mechanism of Action: In the presence of hydrogen ions, sodium bicarbonate dissociates to sodium and carbonic acid, the carbonic acid picks up a hydrogen ion changing to bicarbonate and then dissociates into water and CO2, functioning as an effective buffer and alkalizing the blood. In summary, increases plasma bicarbonate, which can buffer metabolic acids and move TCAs and phenobarbital off receptor sites and back into circulation. 

Onset of Action	Peak Effect	Duration of Action
Rapid	Fast	8-10 minutes