SODIUM BICARBONATE

Class

Alkalinizing agent

Pharmacology and Actions

1. Sodium bicarbonate is an alkalotic solution, which neutralizes acids found in the body. Acids are increased when body tissues become hypoxic due to cardiac or respiratory arrest.

Indications

1. Tricyclic overdose with arrhythmias, widened QRS complex, hypotension, and seizures.
2. Consider in patients with prolonged cardiac arrest.
3. Consider in dialysis patients with cardiac arrest (presumed secondary to hyperkalemia).

Contraindications

1. Alkalotic states

Precautions

1. Addition of too much sodium bicarbonate may result in alkalosis. Alkalosis is very difficult to reverse and can cause as many problems in resuscitation as acidosis.
2. Not to be given with catecholamines or calcium
3. May increase cerebral acidosis

Administration

1. Contact medical control with any questions or concerns.
2. For cardiac arrest / tricyclic overdose:
   1. Adult:       1 mEq/kg IV/IO
   2. Pediatric: 1 mEq/kg IV/IO
   3. Neonatal: 1 mEq/kg IV/IO

Side Effects and Special Notes

1. Sodium bicarbonate administration increases C0₂ which rapidly enters cells, causing a paradoxical intracellular acidosis.
2. Hyperosmolality of the blood can occur, resulting in cerebral impairment.
3. Sodium bicarbonate's lack of proven efficacy and its numerous adverse effects have lead to the reconsideration of its role in cardiac resuscitation. Effective ventilation and circulation of blood during CPR are the most effective treatments for academia associated with cardiac arrest.
4. Administration of sodium bicarbonate has not been proven to facilitate ventricular defibrillation or to increase survival in cardiac arrest. Metabolic acidosis lowers the threshold for the induction of ventricular fibrillation, but has no effect on defibrillation threshold.
5. The inhibition effect of metabolic acidosis on the actions of catecholamines has not been demonstrated at the pH levels encountered during cardiac arrest.
6. Metabolic acidosis from medical causes (e.g. diabetes) develops slowly, and field treatment is rarely indicated.
7. Sodium bicarbonate may be considered for the dialysis patient in cardiac arrest due to suspected hyperkalemia.