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treatment_sodium_bicarbonate [2025/04/13 01:44] – jkohtstreatment_sodium_bicarbonate [2025/04/16 04:26] (current) – [2.2 Salicylate Toxicity] jkohts
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 ===== - Overview ===== ===== - Overview =====
 +Sodium bicarbonate (NaHCO₃) is primarily used in toxicology to treat sodium channel blocker toxicity (e.g. TCA toxicity). 
  
- +The patient should then be [[concept_serum_alkalinization|hyperventilated]].
-Sodium Bicarbonate (NaHCO3) is the primary antidote for [[:wikitox:2.1.11.9.2.1_tricyclic_antidepressants|TCA]] poisoning. As these are, by far, the most common cause of cardiac arrest in out of hospital poisonings - patients with drug overdose presenting in cardiac arrest or arresting shortly after arrival should receive a bolus of 1 ampoule of NaHCO<sub>3</sub>. +
- +
-The patient should then be [[:wikitox:alkalinisation|hyperventilated]].+
  
  
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   * Also see: Tricyclic antidepressants, bupropion, propranolol, flecainide, local anesthetic agents.   * Also see: Tricyclic antidepressants, bupropion, propranolol, flecainide, local anesthetic agents.
   * **Adult:**   * **Adult:**
-    * 💊 **Sodium Bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), q2min.+    * 💊 **Sodium bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), q2min.
   * **Child:**   * **Child:**
-    * 💊👶 **Sodium Bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), q2min.+    * 💊👶 **Sodium bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), q2min.
   * Repeat boluses until signs of cardiotoxicity (QRS widening, wide complex dysrhythmias) improve.   * Repeat boluses until signs of cardiotoxicity (QRS widening, wide complex dysrhythmias) improve.
   * Do not exceed serum pH 7.55, Na⁺ 155 mmol/L.   * Do not exceed serum pH 7.55, Na⁺ 155 mmol/L.
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   * Alkalinization therapy in salicylate toxicity works by ↓ CNS redistribution of salicylates (alters drug distribution), and enhances urinary elimination (ion trapping).   * Alkalinization therapy in salicylate toxicity works by ↓ CNS redistribution of salicylates (alters drug distribution), and enhances urinary elimination (ion trapping).
   * **Adult:**   * **Adult:**
-    * 💊 **Sodium Bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), as initial dose, then start infusion. +    * 💊 **Sodium bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), as initial dose, then start infusion. 
-    * 💊 **Sodium Bicarbonate 25 mmol/hr IV infusion**. +    * 💊 **Sodium bicarbonate 25 mmol/hr IV infusion**. 
-      * e.g. 150 mmol of Sodium Bicarbonate in 850 mL 5% dextrose, at 250 mL/hr.+      * e.g. 150 mmol of Sodium bicarbonate in 850 mL 5% dextrose, at 250 mL/hr.
   * **Child:**   * **Child:**
-    * 💊👶 **Sodium Bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), as initial dose, then start infusion. +    * 💊👶 **Sodium bicarbonate 1-2 mmol/kg IV** (i.e. 1-2 mL/kg of 8.4% NaHCO3), as initial dose, then start infusion. 
-    * 💊👶 **Sodium Bicarbonate 1.5-2× patient's hourly maintenance fluid requirement (weight-based) IV infusion**, then titrate to goal pH. +    * 💊👶 **Sodium bicarbonate 1.5-2× patient's hourly maintenance fluid requirement (weight-based) IV infusion**, then titrate to goal pH.
-  * Maintain normokalemia.+
   * Goals:   * Goals:
     * Serum pH 7.5-7.55.     * Serum pH 7.5-7.55.
     * Urinary pH >7.5.     * Urinary pH >7.5.
     * Urine output 2-3 mL/kg/hr.     * Urine output 2-3 mL/kg/hr.
 +    * Maintain normokalemia.
  
  
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 ===== - Special Populations ===== ===== - Special Populations =====
  
-**Renal impairment:** +**Renal impairment:** Use with caution in patients with severe renal impairment due to the risk of fluid overload and hypernatremia.
- +
-**Hepatic impairment:**+
  
  
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 ==== - Pharmacodynamics ==== ==== - Pharmacodynamics ====
-**Mechanism of action:** Hypertonic Sodium Bicarbonate ameliorates toxicity by multiple mechanisms, including ↑ extracellular sodium concentration, ↑ plasma bicarbonate concentration, ↑ serum pH, and ↑ urinary pH. +**Mechanism of action:** Hypertonic sodium bicarbonate (e.g. 8.4%) ameliorates toxicity by multiple mechanisms, including ↑ extracellular sodium concentration, ↑ plasma bicarbonate concentration, ↑ serum pH, and ↑ urinary pH. 
  
  
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 ==== - Pharmaceutics ==== ==== - Pharmaceutics ====
-**Formulation:** +**Formulation:**  Sodium bicarbonate 8.4% vials/ampoules contain 1 mmol/mL of sodium bicarbonate solution.