SODIUM BICARBONATE

Indications & Dose:

Adult

Acidosis:

IV INF 100-350 mEq over 4-8 hr depending on CO2 and pH

Cardiac arrest:

IV bolus 1 mEq/kg, then 0.5 mEq/kg q10min prn while arrest continues (based on ABGs)

Alkalinization of urine:

PO 325 mg-2 g qid

Antacid:

PO 300 mg-2 g chewed, taken with H2O qd-qid

Child 6-12 yr

Acidosis:

IV INF 2-5 mEq/kg over 4-8 hr depending on CO2 and pH

Cardiac arrest:

IV bolus 1 mEq/kg, then 0.5 mEq/kg q10 min prn while arrest continues (based on ABGs)

Alkalnization of urine:

PO 12-120 mg/kg/day

Antacid:

520mg; may repeat in 30 min

Infant

Acidosis:

IV INF not to exceed 8 mEq/kg/day based on ABGs (4.2% sol)

Contraindications:

Continued losses from vomiting or GI suction; diuretic-induced hypochloremic alkalosis 

Side Effects:

CNS: Confusion, headache, hyperreflexia, irritability, seizures caused by alkalosis, stimulation, tetany, tremors, twitching, weakness
CV: Cardiac arrest, edema, irregular pulse, water retention, weight gain
GI: Acid rebound, belching, cramps, distension, flatulence, increase thirst, paralytic ileus
GU: Calculi
METAB: Alkalosis, hypercalcemia or milk-alkali syndrome, hypokalemia
RESP: Apnea, cyanosis, shallow, slow respirations 

Cautions:

Precautions:

CHF, cirrhosis, hypertension, hypocalcemia, toxemia, renal disease

Interaction:

Drugs

• Amphetamines: Sodium bicarbonate inhibits the elimination and increases the effects of amphetamines

• b-blockers: Reduced absorption

• Cefpodoxime: Reduced absorption

• Cefuroxime: Reduced serum levels with reduced antibiotic efficacy

•  Ephedrine: Large doses of sodium bicarbonate increase the serum concentrations of ephedrine

•  Flecainide: Increased urine pH will increase flecainide serum concentration

• Glipize: Enhanced rate of glipizide absorption

•  Glyburide: Enhanced rate of glyburide absorption

• Iron: Reduced iron absorption

• Ketoconazole: Decreased ketoconazole absorption

•  Lithium: Sodium bicarbonate may lower lithium plasma concentrations

•  Methenamine compound: Sodium bicarbonateinduced urinary pH changes interfere with antibacterial activity of methenamine compounds

• Mexiletine: Increased urine pH increases mexiletine concentrations

•  Pseudoephedrine: Sodium bicarbonate-induced urinary pH changes may markedly inhibit the elimination of pseudoephedrine

• Quinidine: Sodium bicarbonate-induced urinary pH changes may increase quinidine concentrations

•  Quinolones: Reduced absorption

• Salicylates: Sodium bicarbonate-induced urinary pH changes can decrease serum salicylate concentrations

• Tetracyclines: Reduced absorption 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: