# Sodium Bicarbonate

#### **GENERIC NAME**

#### Sodium Bicarbonate

#### **TRADE NAME**

#### None

#### **DESCRIPTION**

Sodium bicarbonate is a salt that provides bicarbonate ions to buffer metabolic acidosis. It is used in several emergency situations, such as cardiac arrest, hyperkalemia, and tricyclic antidepressant overdose, to help restore acid-base balance.

#### **HOW SUPPLIED**

Prefilled syringe: 1 mEq/ml

#### **INDICATIONS**

- Tricyclic antidepressant overdose
- Suspected hyperkalemia
- Dialysis-related cardiac arrest
- Crush injury (Medical Control required)
- Cardiac arrest lasting longer than 10 minutes

#### **CONTRAINDICATIONS**

- Allergy or hypersensitivity to sodium bicarbonate

#### **PRECAUTIONS**

1. Sodium bicarbonate precipitates with Calcium Chloride. Flush the IV line with 10 ml of Normal Saline between administering these two medications.

#### **MECHANISM OF ACTION**

Sodium bicarbonate increases the alkalinity of the urine to enhance the excretion of tricyclic antidepressants. It also acts as a buffer, helping to reduce acidosis in emergency situations.

#### **SIDE EFFECTS**

- Few side effects when used appropriately in emergency settings

#### **AUTHORIZATION**

**EMT:** Not authorized

**AEMT:** Not authorized except for crush injury (Medical Control required)

**Paramedic:** Standing order

#### **DOSAGE**

<table border="1" id="bkmrk-patient-type-route-d" style="width: 100%;"><tbody><tr><th style="width: 17.9976%;">Patient Type</th><th style="width: 10.8426%;">Route</th><th style="width: 42.0776%;">Dosage</th><th style="width: 29.0822%;">Maximum Dosage</th></tr><tr><td style="width: 17.9976%;">All patients (except crush injury)</td><td style="width: 10.8426%;">IV/IO push</td><td style="width: 42.0776%;">1 mEq/kg</td><td style="width: 29.0822%;">Determined by patient response and clinical condition</td></tr><tr><td style="width: 17.9976%;">Crush injury (Adult)</td><td style="width: 10.8426%;">IV infusion</td><td style="width: 42.0776%;">1,000 ml of ½ Normal Saline with 100 mEq of Sodium Bicarbonate, infused over 1 hour</td><td style="width: 29.0822%;">Medical Control required</td></tr><tr><td style="width: 17.9976%;">Crush injury (Pediatric)</td><td style="width: 10.8426%;">IV infusion</td><td style="width: 42.0776%;">Consult Medical Control for dosing</td><td style="width: 29.0822%;">Medical Control required</td></tr></tbody></table>

##### **Administration Notes:**

- To prepare the infusion for crush injury, remove 100 ml from a 1,000 ml bag of Normal Saline, then inject 100 mEq of Sodium Bicarbonate and mix well.
- Monitor the patient’s electrolyte levels and acid-base status closely during administration.
- Adjust the dosage based on the patient’s clinical condition and response.