sodium bicarbonate (Antidote) (Rx)

Frequency Not Defined

Tetany

Hypernatremia

Alkalosis

Gastric distension

Hypocalcemia

Hyperosmolality

Milk-alkali syndrome

Pulmonary edema

Contraindications

Patients who are losing chloride by vomiting or from continuous gastrointestinal suction

Patients receiving diuretics known to produce hypochloremic alkalosis

Cautions

Treatment strategies for metabolic acidosis are primarily directed towards the underlying cause; bicarbonate therapy is a temporary measure used for severe acidosis

Specialized texts and protocols should be consulted to guide use; note that sodium bicarbonate 8.4% is a hypertonic solution

Whenever respiratory acidosis is present with metabolic acidosis, both pulmonary ventilation and perfusion must be adequately supported to get rid of excess carbon dioxide

Laboratory determination of patient's acid‐base status is recommended before and during treatment to minimize possibility of overdosage and resultant metabolic alkalosis

Frequent monitoring of serum electrolyte concentrations is essential; to minimize risks of pre‐existing hypokalemia and/or hypocalcemia, these electrolyte disturbances should be corrected prior to initiation of, or concomitantly with, sodium bicarbonate therapy

Solutions containing sodium may cause fluid overload when given in excess, resulting in dilution of serum electrolytes, overhydration, congestive conditions or pulmonary edema

Excessively elevated plasma sodium concentrations may cause dehydration of brain, resulting in somnolence and confusion, which may progress to convulsions, coma, respiratory failure, and ultimately death

Bicarbonate should be given with caution to patients with ‘type A’ lactic acidosis (tissue hypoxia)

Administration of bicarbonate will tend to limit available oxygen, increase lactate production and thus worsen acidosis

Data from the literature are not in favor of use of bicarbonate in treatment of diabetic ketoacidosis with pH values between 6.90 and 7.10

Sodium bicarbonate should be used with caution in patients with cirrhosis

Accidental extravascular injection of hypertonic solutions may cause vascular irritation, chemical cellulitis (because of their alkalinity), subsequently resulting in tissue necrosis, ulceration and /or sloughing at site of injection

The use of scalp veins should be avoided; do not use injection if it contains precipitate; do not use unless solution is clear and container and seal are intact; discard any unused portion

Pregnancy

Animal reproduction studies have not been conducted with sodium bicarbonate; it is also not known whether sodium bicarbonate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; sodium bicarbonate should be given to a pregnant woman only if clearly needed

Lactation

Safety in lactation has not been established; use in lactating women should only be undertaken if expected benefit outweighs possible risk to mother and fetus or child

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations

1g of sodium bicarbonate is equivalent to 11.9 mEq each of sodium and bicarbonate

Pharmacokinetics

8-10 min (PO); 1-2 hr (IV)

Excretion: Urine (<1%)

Onset of action: Rapid (PO); 15 min (IV)