Sodium Bicarbonate (Antidote)

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Sodium Bicarbonate (Antidote)
Brands

DEA Class; Rx

Common Brand Names; 

  • Antidotes, Other

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

Indicated for

  • Cocaine Toxicity
  • Cyanide Toxicity
  • Salicylate Toxicity
  • Barbiturate Toxicity
  • Cardiac Arrest
  • Tricyclic Antidepressant Toxicity

Other Indications & Uses

All Class 1 antidysryhthmics (quinidine, procainamide, encainide, flecainide; cardiac conduction defect)

Antihistamines (H1 blockers & nonsedating varieties)

Amantidine

Ethylene glycol, methanol

Na+ channel blocking drugs in general

Salicylates, phenobarbital, chlorpropamide (see Urinary Alkalinization)

—

Tetany

Hypernatremia

Alkalosis

Gastric distension

Hypocalcemia

Hyperosmolality

Milk-alkali syndrome

Pulmonary edema

—

Pregnancy Category: C

Adult

Cocaine Toxicity

1-2 mEq/kg IV push bolus

Cyanide Toxicity

1-2 mEq/kg IV push bolus

Salicylate Toxicity

100-150 mEq IV with 40-80 mEq of potassium chloride in each liter of D5W; administer at 150-250 mL/hr to maintain higher than normal urine output

Barbiturate Toxicity

1 mEq/kg IV bolus, followed by an IV drip of 1000 mL of D5W to which 2-3 ampules of sodium bicarbonate are added, initiate drip rate at 200 mL/hr, titrate drip rate to blood pH (7.45) and urinary pH (7.5-8)

Cardiac Arrest

Initial: 1 mEq/kg/dose IV push bolus

Maintenance: 0.5 mEq/kg/dose q10min or as indicated by arterial blood gases

Tricyclic Antidepressant Toxicity

Use if QRS >100-200 ms or hypotension

Initial bolus: 1-2 mEq/kg IV push over 1-2 minutes; not to exceed 100 mEq/dose

Follow-up infusion: 100-150 mEq in 1 L D5/0.45% NaCl infused 100-200 mL/hr IV; titrate infusion to achieve blood pH of 7.45-7.55

Pediatric

If acid-base status unavailable, older children may receive 2-5 mEq/kg IV infusion over 4-8 hr; titrate infusion rate to maintain pH of 6-7

Sodium bicarbonate (Antidote)

IV solution

  • 4%
  • 4.2%
  • 7.5%
  • 8.4%
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