Sodium Bicarbonate

bicarb

I rank Sodium Bicarbonate 22 on my list of 33 drugs. I rate it above calcium partly because it links me more closely with Johnny and Roy, and more importantly because it can be used for tricycliate overdose, and for crush injuries (I have never used it for these indications).

I use it only sporadically in cardiac arrest — when I have gone through everything, but am not quite ready to quit, and only then if the patient has renal failure issues.

* crush injuries are not in our protocol, but if we encountered one, we could call medical control for permission to use sodium bicarbonate. It is my understanding that it should only be given for crush injuries of major extremities after lengthy entrapment, and that it should be given just prior to release of the limb from whatever has been crushing it.

***

Sodium Bicarbonate (NaHCO 3 )

Class: Alkalotic agent

Action: Increases protein binding of tricyclic antidepressant and shunts potassium intracellularly as well as increasing renal elimination. Neutralizes acid in the blood. May help pH return to normal limits.

Indication: Tricyclic antidepressant overdose, hyperkalemia (consider strongly if cardiac arrest in renal dialysis patient).

Contraindication: Digitalis, Respiratory acidosis
Not to be used routinely in cardiac arrest (exceptions noted above).

Side effect: Metabolic alkalosis
Lowers K+ which may increase cardiac irritability
Worsens respiratory acidosis if ventilation is inadequate

Dose: 1.0 mEq/kg, may repeat if indicated at initial dose

Route: IV push

4 Comments

  • Matt says:

    One more of those nice-to-know-but-nobody-uses-it indications is a hyponatremic seizure.
    Also, you can add salicylates, chlorpropamide, and phenobarbitol to the list of drugs where the ion-trapping that leads to increased renal eliminations is helpful.

  • Josh says:

    Another good use is for respiratory irritation secondary to inhalants. Specifically as a counter agent against inhaled chloramine (ammonia mixed with chlorine). Either use 5ml of 1/2 bicarb (4.2%) or 2.5 ml standard bicarb with 2.5ml of saline in a nebulizer. Works wonders! Use it about once a year….

  • medicscribe says:

    Thanks for the comments. Very interetsing uses. I will have to our region look into listing these in our guidelines.

    Thanks again,

    Peter

  • Bill Murphy says:

    Peter,
    You should move Bicarb up a notch or three just for what’s probably it’s most common non-EMS use: odor neutralization. Sprinkled gingerly or sprayed directly at a problem area or even nebulized it works great. I’ve used it several times to make it through some rough transports with some nasty stenches. -bill

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Peter Canning

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    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
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