EMS Medication: Sodium Bicarbonate

Trade Name and Classification

Sodium Bicarbonate

Trade name: None

Class: Alkalinizing agent

Desired Effects

Treats and prevents arrhythmias in tricyclic overdoses; rapidly drops potassium levels in serious cases of hyperkalemia especially in dialysis and renal failure patients; improves coronary perfusion when given with epinephrine.

Mechanism of Action

Acts as a source of bicarbonate ions; increases pH (alkalization) in blood and urine; acts as a buffering (neutralizing) agent for acids in the blood and interstitial fluid.

Indications

Metabolic acidosis

Prolonged resuscitation efforts

Tricyclic antidepressant overdose

Hyperkalemia

Contraindications

Congestive heart failure

Metabolic or respiratory alkalosis

Hypokalemia

Hypocalcemia

Adverse Reactions

Hypoxia

Paradoxical CNS acidosis

Metabolic alkalosis

Hypernatremia

Seizures

May slough tissue at injection site (cytotoxic)

Drug Interactions

May precipitate when given with atropine, calcium chloride, morphine aminophylline, and magnesium.

Epinephrine, dopamine, and isopreterenol are inactivated when given with sodium bicarbonate

Precautions

Be sure to have a good flow in IV prior to giving slowly

May worsen CHF

Special Considerations

Adequate ventilation is the mainstay of acid-base balance in cardiac arrest. Sodium bicarbonate is reserved for patients with severe acidosis, or empirically for prolonged resuscitation efforts after ventilation, oxygenation, and perfusion has been established.

Dosing Regimen

Adult:

• Full Arrest (Special Considerations) = 1 mEq/kg IV push

• Renal Emergencies = 50 mEq IVP

• Crush Injury = 1 mEq/kg IVP then add 50 mEq to 1000 ml of NS and infuse at 1000 ml/hr

Protocol Location

Cardiac Arrest

Renal Emergencies

Trauma Emergencies - Crush