Sodium Bicarbonate

Indications:

• Altered level of consciousness and wide complex tachycardia resulting from tricyclic antidepressant (TCA) overdose or ingestion - BIOTEL AUTHORIZATION ONLY
• Cardiac arrest associated with
  • Hyperkalemia
    • renal failure
    • dialysis
    • crush injury/crush syndrome
  • Metabolic acidosis
    • renal failure
    • diabetic ketoacidosis (DKA)
    • methanol ingestion
    • aspirin (ASA) overdose
  • Tricyclic antidepressant (TCA) overdose or ingestion
  • Prolonged (greater than 15 minutes) resuscitation attempt

Contraindications: Not recommended for routine use in cardiac arrest

Precautions:

• Flush IV/IO line well between all drugs
• May inactivate epinephrine or dopamine

Side Effects:

• Alkalosis
• Seizures
• Tissue sloughing at injection site

Adult Dose:

• Standing order when used during cardiac arrest
  • 1 mEq/kg IV/IO slow push
• BioTel authorization required for tricyclic antidepressant toxicity
  • 1 mEq/kg IV/IO slow push

Pediatric Dose:

• Standing order when used during cardiac arrest
  • 1 mEq/kg IV/IO slow push
• BioTel authorization required for tricyclic antidepressant toxicity
  • 1 mEq/kg IV/IO slow push (same as adult)

Route: IV or intraosseous push

Drug Action:

• Drives serum potassium back into the cell
• Enhances urinary excretion of tricyclic antidepressants
• Neutralizes acidosis

Class:

• Electrolyte
• Alkalinizing Agent

Onset: 2 minutes – 10 minutes

Duration: 30 minutes – 60 minutes