sodium Bicarb

Exam 3: Sodium Bicarbonate Medication Notes

General Information

• Sodium Bicarbonate Name Pronunciation:

  • soe-dee-um bye-kar-boe-nate

• Fixed Combinations Available:

  • Konvomep: Sodium bicarbonate/omeprazole (PPI): 84 mg/2 mg/mL.

  • Zegerid: 1,100 mg/20 mg, 1,100 mg/40 mg.

  • Zegerid Powder: 1,680 mg/20 mg, 1,680 mg/40 mg.

Classification

• Pharmacotherapeutic Classification:

  • Alkalinizing agent.

• Clinical Uses:

  • Antacid.

  • Electrolyte supplement.

  • Urinary/systemic alkalinizer.

Uses

• Primary Uses:

  • Treatment of metabolic acidosis due to:

  • Severe renal disease.

  • Uncontrolled diabetes.

  • Circulatory insufficiency from shock, anoxia, or severe dehydration.

  • Treatment of drug intoxications, including:

  • Poisoning by salicylates/methyl alcohol.

  • Hemolytic reactions requiring urine alkalinization.

• Off-Label Uses:

  • Prevention of contrast-induced nephropathy.

  • Management of severe hyperkalemia.

  • Treatment of metabolic acidosis in patients with chronic kidney disease (CKD).

Precautions

• Contraindications:

  • Hypersensitivity to sodium bicarbonate.

  • Hypernatremia.

  • Alkalosis.

  • Unknown abdominal pain.

  • Hypocalcemia.

  • Severe pulmonary edema.

• Cautions:

  • Heart failure (HF).

  • Edematous states.

  • Renal insufficiency.

  • Cirrhosis.

Mechanism of Action

• Action:

  • Dissociates to provide bicarbonate ions in the body.

• Therapeutic Effect:

  • Neutralizes hydrogen ion concentration.

  • Raises blood and urinary pH.

Pharmacokinetics

• Route of Administration:

  • Oral (PO): Onset in 15 minutes, Duration of 1-3 hours.

  • Intravenous (IV): Immediate onset, Duration of 8-10 minutes.

• Distribution:

  • Widely distributed in the body.

• Bicarbonate Ion Dynamics:

  • In presence of increased hydrogen ion concentrations, bicarbonate ions react with hydrogen ions, forming carbonic acid, which dissociates into carbon dioxide (CO2), excreted by the lungs.

  • Plasma concentration regulated by the kidneys, which determine the ability to form and excrete bicarbonate.

Lifespan Considerations

• Pregnancy/Lactation:

  • Possible hypernatremia and increased tendon reflexes in neonate or fetus with chronic high-dose administration.

  • May be distributed into breast milk.

• Children:

  • No significant age-related precautions.

  • Do not use as an antacid in patients under 6 years of age.

• Elderly:

  • Age-related renal impairment may necessitate dosage adjustments.

Interactions

• Drug Interactions:

  • May increase concentration and toxicity of:

  • Quinidine.

  • Quinidine.

• Herbal Interactions:

  • No significant interactions noted.

• Food Interactions:

  • Dairy products may lead to milk-alkali syndrome.

• Laboratory Values:

  • May increase serum and urinary pH values.

Availability

• Prescription Injection Solution:

  • Concentrations of 0.5 mEq/mL, 1 mEq/mL.

Administration/Handling

• IV Administration Alert:

  • For neonates or infants: Use 0.5 mEq/mL concentration.

• Reconstitution:

  • May be given undiluted.

• Rate of Administration:

  • For IV Push:

  • Up to 1 mEq/kg over 1-3 minutes in cases of cardiac arrest.

  • For IV Infusion:

  • Do not exceed infusion rate of 1 mEq/kg/hr.

  • For patients younger than 2 years:

  • Administer by slow infusion, up to 10 mEq/min.

• Storage:

  • Store at room temperature.

• Oral Administration:

  • Administer 1-3 hours after meals.

IV Incompatibilities

• Incompatibilities:

  • Calcium chloride.

IV Compatibilities

• Compatible with:

  • Dexmedetomidine.

  • Heparin.

  • Insulin.

  • Potassium chloride.

Indications/Routes/Dosage

• General Alert:

  • Can be administered via IV push, IV infusion, or orally.

  • Dosage individualized based on:

  • Severity of acidosis.

  • Laboratory values.

  • Patient age, weight, and clinical condition.

  • Do not fully correct bicarbonate deficit during the first 24 hours to avoid metabolic alkalosis.

• Cardiac Arrest: Alert:

  • Routine use not recommended.

  • IV Dosage for Adults/Elderly:

  • Initially, 1 mEq/kg; repeat based on arterial blood gases.

  • Children/Infants:

  • Initially, 0.5-1 mEq/kg; repeat based on arterial blood gases.

• Prevention of Contrast-Induced Nephropathy:

  • IV Infusion Dosage for Adults/Elderly:

  • 154 mEq/L sodium bicarbonate in D5W solution at:

    • 3 mL/kg/hr for 1 hour before contrast injection.

    • 1 mL/kg/hr during contrast exposure and for 6 hours after the procedure.

• Metabolic Acidosis:

  • Adults/Elderly Dosage:

  • Mild acidosis: 1-2 mEq/kg of body weight administered slowly.

  • More severe acidosis: 2-5 mEq/kg over a 4-8 hour period, subsequent therapy based on clinical response.

Side Effects

• Frequent Side Effects:

  • Abdominal distention.

  • Flatulence.

  • Belching.

Adverse Effects/Toxic Reactions

• Potential Complications from Excessive or Chronic Use:

  • Metabolic alkalosis (symptoms include irritability, twitching, paresthesia, cyanosis, slow or shallow respirations, headache, thirst, nausea).

  • Fluid overload may result in:

  • Headache.

  • Weakness.

  • Blurred vision.

  • Behavioral changes.

  • Incoordination.

  • Muscle twitching.

  • Elevated blood pressure.

  • Bradycardia.

  • Tachypnea.

  • Wheezing/Coughing.

  • Distended neck veins.

  • Extravasation at the IV site may result in:

  • Tissue necrosis.

  • Ulceration.

Nursing Considerations

• Baseline Assessment:

  • Assess for symptoms indicating acidosis or alkalosis.

  • Avoid administering oral medication within 1 hour of antacids.

• Intervention/Evaluation:

  • Monitor:

  • Serum and urinary pH.

  • CO2 levels.

  • Serum electrolytes.

  • Plasma bicarbonate levels.

  • Watch for signs of metabolic alkalosis or fluid overload.

  • Clinical improvement of metabolic acidosis (relief from symptoms like hyperventilation, weakness, disorientation).

  • Serum phosphate, calcium, and uric acid levels.

  • Relief of gastric distress.