Additives may be incompatible. Consult with pharmacist, if available. When introducing additives, use aseptic technique, mix throughly and do not store. The aim of all bicarbonate therapy is to produce a substantial correction of the low total CO2 content and blood pH, but the risks of overdosage and alkalosis should be avoided.
Hence, repeated fractional doses and periodic monitoring by appropriate laboratory tests are recommended to minimize the possibility of overdosage. Pregnancy Category C: Animal reproduction studies have not been conducted with sodium bicarbonate. It is also not known whether sodium bicarbonate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.
Sodium bicarbonate should be given to a pregnant woman only if clearly needed. Overly aggressive therapy with Sodium Bicarbonate Injection, USP can result in metabolic alkalosis associated with muscular twitchings, irritability and tetany and hypernatremia. Inadvertent extravasation of intravenously administered hypertonic solutions of sodium bicarbonate have been reported to cause chemical cellulitis because of their alkalinity, with tissue necrosis, ulceration or sloughing at the site of infiltration.
Prompt elevation of the part, warmth and local injection of lidocaine or hyaluronidase are recommended to prevent sloughing of extravasated IV infusions. Should alkalosis result, the bicarbonate should be stopped and the patient managed according to the degree of alkalosis present.
Severe alkalosis may be accompanied by hyperirritability or tetany and these symptoms may be controlled by calcium gluconate. An acidifying agent such as ammonium chloride may also be indicated in severe alkalosis.
In cardiac arrest, a rapid intravenous dose of to mEq of bicarbonate, given as a 7. Cautions should be observed in emergencies where very rapid infusion of large quantities of bicarbonate is indicated. Bicarbonate solutions are hypertonic and may produce an undesirable rise in plasma sodium concentration in the process of correcting the metabolic acidosis.
In cardiac arrest, however, the risks from acidosis exceed those of hypernatremia. Slow administration rates and a solution diluted to 4. In less urgent forms of metabolic acidosis, Sodium Bicarbonate Injection, USP may be added to other intravenous fluids. Bicarbonate therapy should always be planned in a stepwise fashion since the degree of response from a given dose is not precisely predictable.
The next step of therapy is dependent upon the clinical response of the patient. If severe symptoms have abated, then the frequency of administration and the size of the dose may be reduced. Error Include a valid email address. To provide you with the most relevant and helpful information and to understand which information is beneficial, we may combine your e-mail and website usage information with other information we have about you.
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Because of these potential harms, most experts agree that we should NOT be administering bicarbonate to patients with lactic acidosis and a serum pH greater than 7. Probably not a panacea to fix everything when the situation is THAT dire.
At the end of the day - case by case basis, sometimes bridge to CRRT. Cases where you should consider bicarbonate in lactic acidosis:. Metabolic alkalosis as soon as perfusion is restored harmful. Definitely give if hyperK or sodium channel blocker suspected etiology. Sign In My Account. Back Podcasts Blog. Lactic Acidosis Because of these potential harms, most experts agree that we should NOT be administering bicarbonate to patients with lactic acidosis and a serum pH greater than 7.
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