Sodium Bicarbonate (NaHCO3) is the primary antidote for 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 NaHCO₃.

The patient should then be hyperventilated.

• Also see: Tricyclic antidepressants, bupropion, propranolol, flecainide, local anesthetic agents.
• Adult:
  • 💊 Sodium Bicarbonate 1-2 mmol/kg IV (i.e. 1-2 mL/kg of 8.4% NaHCO3), q2min.
• Child:
  • 💊👶 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.
• Do not exceed serum pH 7.55.

• Also see: Salicylate toxicity.
• Alkalinization therapy in salicylate toxicity works by ↓ CNS redistribution of salicylates (alters drug distribution), and enhances urinary elimination (ion trapping).
• 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 25 mmol/hr IV infusion.
    • e.g. 150 mmol of Sodium Bicarbonate in 850 mL 5% dextrose, at 250 mL/hr.
• 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 1.5-2× patient's hourly maintenance fluid requirement (weight-based) IV infusion, then titrate to goal pH.
• Maintain normokalemia.
• Goals:
  • Serum pH 7.5-7.55.
  • Urinary pH >7.5.
  • Urine output 2-3 mL/kg/hr.

• Also see: relevant pages.
• Adult: 💊 DrugName Dose Route, Frequency.
• Child: 💊👶 DrugName Dose Route, Frequency.
• Other notes if applicable.

• Metabolic or respiratory alkalosis
• Severe hypernatremia
• Hypokalemia
• Acute pulmonary edema

Pregnancy rating:

Lactation:

Renal impairment:

Hepatic impairment:

• Description of important/serious adverse effects, e.g.
• Serotonin syndrome:
• Systems e.g.
• GI:
• Resp:
• MSK: local phlebitis
• Frequency e.g.
• Common:

Mechanism of action:

Absorption:

• Oral bioavailability:
• GI tract absorption:
• First pass metabolism:

Distribution:

• Vd:
• Lipid solubility:
  • Crosses/Does not cross BBB
  • Crosses/Does not cross placenta
  • Excreted/Not excreted in breast milk
• Protein binding:
• Tmax:

Metabolism:

Excretion:

• Elimination t½:
• Hepatic clearance:
• Renal clearance:

Formulation:

Useful general references: