Given IV: Immediately raises blood pH by buffering excess H+ cations. Excess bicarbonate ions are excreted in urine thus making urine less acidic.
Indications
Severe acidosis refractory to hyperventilation
Tricyclic antidepressant overdose
Barbituate overdose
Known hyperkalemia
Contraindications
None in emergency setting
Precautions
Not recommended for routine use in cardiac arrest
Dosage must be specific to prevent metabolic acidosis and is thus weight based
Side Effects
Severe necrosis if extravasation occurs
May produce paradoxical acidosis that can depress cerebral and cardiac function
May cause extracellular alkalosis which may reduce the concetration of ionized calcium, decrease plasma potassium, and induce a left shift of the oxyhemoglobin curve which may inhibit oxygen release to the tissues and induce malignant dysrhythmias
Interactions
Will deactivate most catecholamines and vasopressors
Sodium bicarbonate will form precipitate in conjunction with calcium chloride