Pharmacology: Pharmacodynamics: Sodium bicarbonate therapy increases plasma bicarbonate, buffers excess hydrogen ion concentration, raises blood pH and reverses clinical manifestations of metabolic acidosis.
Pharmacokinetics: Sodium bicarbonate is eliminated principally in the urine and effectively alkalises it.
Sodium Bicarbonate Injection is indicated in adults and children for: Correction of metabolic acidosis associated with cardiac arrest in patients with pre-existing acidosis; Cardiac arrest associated with hyperkalaemia with pre-existing metabolic acidosis; Life-threatening hyperkalaemia with pre-existing metabolic acidosis; Tricyclic antidepressant Sodium bicarbonate should only be used after other resuscitative measures such as cardiac compression, ventilation, adrenaline and antiarrhythmic agents have been attempted.
In neonates, Sodium Bicarbonate is indicated for: Correction of metabolic acidosis associated with cardiac arrest in patients with pre-existing acidosis; Cardiac arrest associated with hyperkalaemia with pre-existing metabolic; Life threatening hyperkalaemia with pre-existing metabolic.
No benefits have been demonstrated from the routine use of sodium bicarbonate in resuscitation of neonates. In neonates, sodium bicarbonate is recommended in resuscitation only in cases of prolonged cardiac arrest, irresponsive to other therapy, after establishment of adequate ventilation and circulation.
The dosage depends largely on the extent of the acid-base imbalance. This should be checked regularly.
Administration is via slow intravenous injection.
For intravenous administration only.
Adults: The usual dose is 1 mmol/kg (1 mL/kg 8.4% solution) followed by 0.5 mmol/kg (0.5 mL/kg 8.4% solution) given at 10 minute intervals.
Children: The usual dose is 1 mmol/kg by slow IV injection. (1 mL/kg 8.4% solution).
In premature infants and neonates, the 4.2% solution should be used or 8% solution should be diluted 1:1 with 5% dextrose.
Symptoms: Metabolic alkalosis accompanied by compensatory hyperventilation, paradoxical acidosis of the cerebrospinal fluid, severe hypokalaemia, hyperirritability and tetany.
Treatment: Discontinue the administration of sodium bicarbonate, rebreathe expired air or, if more severe administer calcium gluconate especially if tetany is present. In severe alkalosis, an infusion of 2.14% ammonium chloride is recommended, except in patients with pre-existing hepatic disease. If hypokalaemia is present administer potassium chloride.
Administration of sodium bicarbonate is contraindicated in patients with renal failure, metabolic or respiratory alkalosis, hypertension, oedema, congestive heart failure, a history of urinary calculi and coexistent potassium depletion or hypocalcaemia, hypoventilation, chloride depletion or hypernatraemia.
Whenever sodium bicarbonate is used intravenously, arterial blood gas analyses, in particular arterial/venous blood pH and carbon dioxide levels, should be performed before and during the course
of treatment to minimise the possibility of overdosage and resultant alkalosis.
Accidental extravascular injection of hypertonic solutions may cause vascular irritation or sloughing. The
use of scalp veins should be avoided.
Whenever respiratory acidosis is concomitant with metabolic acidosis, both pulmonary ventilation and perfusion must be adequately supported to get rid of excess CO2.
Safe use in pregnancy has not been established. The use of any drug in pregnant or lactating women requires that the expected benefit be carefully weighed against the possible risk to the mother and
Patients requiring i.v. sodium bicarbonate are unlikely to be fit enough to breast feed.
Metabolism and Nutrition Disorders:
Alkalosis, hypokalaemia, hypernatremia, hyperosmolarity, hypocalcemia, hypoglycemia, paradoxical intracellular acidosis.
Deterioration of hemodynamic status associated with volume overload.
Nervous System Disorders:
Intracranial hemorrhage (in neonates), hyperirritability or tetany.
General Disorders and Administration Site Conditions:
Incorrect administration (intra-arterial, pa ravenous) may cause tissue necrosis.
Caution should be used when administering sodium ions to patients receiving corticosteroids or corticotrophin.
Urinary alkalinisation will increase the renal clearance of medicinal products which are acid in nature e.g. tetracyclines, especially doxycycline, acetylsalicylic acid, chlorpropamide, lithium, methenamine. It increases the half-life and duration of action of basic drugs such as quinidine, amphetamines, ephedrine, pseudoephedrine, memantine and flecainide. Sodium bicarbonate is known to increase renal tubular
reabsorption of mecamylamine causing hypotension.
Hypochloraemic alkalosis may occur if sodium bicarbonate is used in conjunction with potassium depleting diuretics such as bumetanide, ethacrynic acid, furosemide and thiazides.
Concurrent use in patients taking potassium supplements may reduce serum potassium concentration by promoting an intracellular ion shift.
B05CB04 - sodium bicarbonate ; Belongs to the class of salt solutions used as irrigating solutions.
Soln for inj (amp) 84 mg/mL x 20 mL x 50's.