Patients should address specific medical concerns with their physicians. Toggle navigation. Pharmacology Chapter. Page Contents Precautions Not a first line drug for Resuscitation Treat acidosis with ventilation and perfusion Bicarbonate has not been shown to improve survival Bicarbonate may transiently depress CV parameters Cardiac Function Coronary Artery perfusion. Preparations: Intravenous Concentrations Bicarbonate 4. These interactions are due to the effects of sodium bicarbonate on increasing renal tubular pH, thereby increasing passive tubular reabsorption and increasing serum levels of medication.
Rapid or high-dose administration of undiluted sodium bicarbonate may lead to decreased CSF pressure and intracranial hemorrhage, particularly in the pediatric population under the age of 2.
Another contraindication is for those that have hypersensitivity to sodium bicarbonate injections. Clinicians should monitor serum electrolytes, including calcium, urinary pH, and when indicated, arterial blood gases.
Rapid administration of sodium bicarbonate may increase intravascular fluid volume, leading to acute pulmonary edema. Additionally, the medication must be administered judiciously in those with congestive heart failure, significant renal disease, or sodium retention due to exacerbation of sodium retention and edema. Sodium bicarbonate administration in a rapid infusion or as large boluses can result in acute metabolic alkalosis resulting in reduced serum ionized calcium. This acute shift in ionized calcium can result in tetany.
This severe alkalosis is potentially treatable with ammonium chloride. Hypocalcemia may be addressed with calcium gluconate. An addition of 0. Appropriate use of sodium bicarbonate and preventing its potential adverse effects require the involvement of the entire allied interprofessional team of healthcare professionals. Clinicians need to ensure that sodium bicarbonate is the appropriate therapeutic choice.
Nursing will either administer the drug if the patient is inpatient or give instructions for home administration for outpatient use and counsel regarding potential adverse events. Pharmacists will verify appropriate dosing, perform medication reconciliation checking for drug-drug interactions, and reinforce patient counseling points where appropriate.
Utilizing an interprofessional approach to sodium bicarbonate therapy will increase the chances of therapeutic success while minimizing adverse events, which will result in better patient outcomes.
Despite consistent, systematic checkpoints in evaluating negative outcomes, the clinical observation and recognition at the bedside consistently improve morbidity and mortality in the setting of patient medication errors, medication-induced reactions, and side effects.
A comparative study of two methods. Arieff AI, Indications for use of bicarbonate in patients with metabolic acidosis. British journal of anaesthesia.
International journal of nephrology. Journal of basic and clinical physiology and pharmacology. Southern medical journal. Pentel P,Benowitz N, Efficacy and mechanism of action of sodium bicarbonate in the treatment of desipramine toxicity in rats.
The Journal of pharmacology and experimental therapeutics. Annals of emergency medicine. Journal of clinical medicine research. Current opinion in critical care. Prompt elevation of the part, warmth and local injection of lidocaine or hyaluronidase are recommended to prevent sloughing of extravasated IV infusions.
Should alkalosis result, the bicarbonate should be stopped and the patient managed according to the degree of alkalosis present. Severe alkalosis may be accompanied by hyperirritability or tetany and these symptoms may be controlled by calcium gluconate.
An acidifying agent such as ammonium chloride may also be indicated in severe alkalosis. In cardiac arrest, a rapid intravenous dose of to mEq of bicarbonate, given as a 7. Cautions should be observed in emergencies where very rapid infusion of large quantities of bicarbonate is indicated. Bicarbonate solutions are hypertonic and may produce an undesirable rise in plasma sodium concentration in the process of correcting the metabolic acidosis.
In cardiac arrest, however, the risks from acidosis exceed those of hypernatremia. Slow administration rates and a solution diluted to 4. In less urgent forms of metabolic acidosis, Sodium Bicarbonate Injection, USP may be added to other intravenous fluids. Bicarbonate therapy should always be planned in a stepwise fashion since the degree of response from a given dose is not precisely predictable.
The next step of therapy is dependent upon the clinical response of the patient. If severe symptoms have abated, then the frequency of administration and the size of the dose may be reduced. In general, it is unwise to attempt full correction of a low total CO2 content during the first 24 hours of therapy, since this may be accompanied by an unrecognized alkalosis because of a delay in the readjustment of ventilation to normal.
Further modification of the acidosis to completely normal values usually occurs in the presence of normal kidney function when and if the cause of the acidosis can be controlled. Values for total CO2 which are brought to normal or above normal within the first day of therapy are very likely to be associated with grossly alkaline values for blood pH, with ensuing undesired side effects.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not use unless solution is clear and the container or seal is intact. Discard unused portion. Revised October, Hospira, Inc. Clinical Pharmacology Intravenous sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses the clinical manifestations of acidosis.
Indications and Usage Sodium Bicarbonate Injection, USP is indicated in the treatment of metabolic acidosis which may occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration, extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis.
Contraindications Sodium Bicarbonate Injection, USP is contraindicated in patients who are losing chloride by vomiting or from continuous gastrointestinal suction, and in patients receiving diuretics known to produce a hypochloremic alkalosis.
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