Ver el código de «Sodium bicarbonate»

==Administration==
*Type: 8.4% is common cardiac formulation
**8.4% is 1 mEq/mL
*Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
*Routes of Administration: IV
*Common Trade Names: N/A
*Abbreviation: NaHOC3
{{Dosing Variables}}

==Adult Dosing==
===[[Cardiac Arrest]]===
{{#var:bicarbmax}} mL (1 amp) IV push for severe acidemia and patient is adequately ventilated
*Frequency<ref>eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749</ref>:
**1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
**0.5 mEq/kg/dose q10min
**'''OR''' tailor to serial ABGs

===Severe [[Metabolic Acidemia]] (pH<7.1) ===
*IV drip
**150 mEq/1000 mL inD5W 
**May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis (although this study used 4.2% sodium bicarbonate, a product not widely available within the United States)<ref>Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.</ref>

===Serum alkalinization (toxicology)===
*Enhance urinary elimination of salicylates, methotrexate and phenobarbital
*Goal: serum pH of 7.5, urinary pH of 8.0
*Check K+ as well
*IV drip
**150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour

==Pediatric Dosing==
===[[Cardiac Arrest]]===
*{{#var:bicarb}} mL/kg IV push for severe acidemia and patient is adequately ventilated
*Sodium bicarbonate administration in cardiac arrest has not been shown to improve survival to discharge<ref>Dybvik T, Strand T, Steen PA. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 1995 Apr;29(2):89-95. doi: 10.1016/0300-9572(95)00850-s. PMID: 7659873.</ref><ref>Vukmir RB, Katz L; Sodium Bicarbonate Study Group. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006 Mar;24(2):156-61. doi: 10.1016/j.ajem.2005.08.016. PMID: 16490643.</ref>
*ACLS guidelines recommend against routine use of sodium bicarbonate in cardiac arrest although there may be benefit in the setting of cardiac arrest caused by [[hyperkalemia]] or [[Tricyclic antidepressant toxicity|tricyclic antidepressant]] overdose

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: C
*[[Lactation risk categories|Lactation risk]]: Infant risk minimal
===Renal Dosing===
*Adult:
*Pediatric:
===Hepatic Dosing===
*Adult:
*Pediatric:

==Contraindications==
*Allergy to class/drug
*Relative:
**Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia)
**[[DKA]] with pH > 7.1

==Adverse Reactions==
===Serious===
*Extravasation: [[cellulitis]], tissue necrosis, ulcer
*[[Metabolic alkalosis]]
*[[Hypernatremia]] <ref>Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, Hargarten KM, Thompson B. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992 Jan;10(1):4-7. doi: 10.1016/0735-6757(92)90115-e. PMID: 1736913.</ref>

===Common===

==Pharmacology==
*Onset: 15 minutes (IV)
*Duration: 1-2 hours (IV)
*Half-life: 
*Metabolism: 
*Excretion:

==Mechanism of Action==
*Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH

==Comments==
*'''Sodium acetate''' can be used as a substitute for sodium bicarbonate during times of critical shortages<ref>Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.</ref>
**Can be used to treat [[TCA toxicity|TCA]] and [[ASA toxicity]]
**Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension

==See Also==

==References==
<references/>
[[Category:Pharmacology]]
[[Category:Critical Care]]