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 ½ initial dose
Route: IV push