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Drug Therapy Protocols: Sodium bicarbonate 8.4%

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Date October, 2016

Purpose To ensure a consistent procedural approach to Sodium bicarbonate 8.4% administration.

Scope Applies to all QAS clinical staff.

Author Clinical Quality & Patient Safety Unit, QAS

Review date October, 2018

URL https://ambulance.qld.gov.au/clinical.html

891QUEENSLAND AMBULANCE SERVICE

Drug classAlkalising agent

Pharmacology Sodium bicarbonate 8.4% is a hypertonic solution that acts as a buffer.

Excess hydrogen ions react with bicarbonate resulting in the formation of carbon dioxide and water. This action assists in restoring plasma pH to within normal ranges.[1–3]

MetabolismMetabolised to CO2 and H2O.[1]

Presentation

Onset (IV) Duration (IV) Half-life

Immediate

• Vial, 100 mL sodium bicarbonate 8.4%

Sodium bicarbonate 8.4%

Contraindications

• Nil

Indications

• Cardiac arrest:

- secondary to suspected hyperkalaemia (e.g. chronic renal failure)

- secondary to tricyclic antidepressant (TCA) overdose

• Significant injury with potential for crush syndrome

• TCA overdose with QRS > 0.12 OR attributed seizure activity

• Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

Side effects

• Cerebral oedema

• Congestive heart failure

Variable Variable

Precautions

• Nil

October, 2016

Figure 4.51

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QUEENSLAND AMBULANCE SERVICE 892

Special notes

• Care must be taken to avoid extravasation into tissues as necrosis may occur.

• Sodium bicarbonate 8.4% administration is not indicated in the newly born pre-hospital resuscitation.

• The Phebra branded sodium bicarbonate vials are unable to be spiked with QAS supplied Alaris® giving sets. All medication must be withdrawn and administered using a 50 mL syringe and 19G drawing up needle.

• All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% before and following each

medication administration.

• All parenteral medications must be prepared in an aseptic

manner. The rubber stopper of all vials must be disinfected

with a 2% Chlorhexidine/70% Isopropyl Alcohol swab and allowed to dry prior to piercing.

Routes of administration

Intravenous injection (IV)

Intraosseous injection (IO)

Adult dosages

IV ECP – QAS Clinical Consultation and Advice Line approval required in all situations.100 mL. Single dose only.

IO 100 mL. Single dose only.

IV ECP – QAS Clinical Consultation and Advice Line approval required in all situations.

100 mL Repeated every 5 minutes.Total maximum dose 300 mL.

IO 100 mL Repeated every 5 minutes.Total maximum dose 300 mL.

Schedule

• Unscheduled.

• Cardiac arrest- secondary to suspected hyperkalaemia

(e.g. chronic renal failure)

- secondary to TCA overdose

• Significant injury with potential for crush syndrome

• Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

TCA overdose with QRS > 0.12 OR attributed seizure activity

Sodium bicarbonate 8.4%

ECP

CCP

ECP

CCP

CCP

ECP

CCP

CCP

CCP

October, 2016

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893

Paediatric dosages

IV ECP – QAS Clinical Consultation and Advice Line approval required in all situations.

1 mL/kgSingle dose only.

IO 1 mL/kgSingle dose only.

• Cardiac arrest- secondary to suspected hyperkalaemia

(e.g. chronic renal failure)

- secondary to TCA overdose

• Significant injury with potential for crush syndrome

• Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation)

CCP

ECP

CCP

894 QUEENSLAND AMBULANCE SERVICE

Sodium bicarbonate 8.4%

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