Sodium
Bicarbonate
Trade names: Neut
Class: Alkali
Pregnancy:
(Category C) Action:
Sodium bicarbonate is a systemic alkalizing
agent which, when given intravenously will increase plasma bicarbonate, buffers
excess hydrogen ion concentration, raises blood pH and reverses the clinical
manifestations of acidosis.
Uses:
Sodium bicarbonate is used as an alkalinizing
agent in the treatment of metabolic acidosis which may occur in many conditions
including diabetes, starvation, hepatitis, cardiac arrest, shock, severe
dehydration, renal insufficiency, severe diarrhea, Addison's disease or
administration of acidifying salts (e.g. excessive sodium chloride, calcium
chloride, ammonium chloride).
Sodium bicarbonate is also used to increase
urinary pH in order to increase the solubility of certain weak acids (e.g.
cystine, sulphonamides, uric acid) and in the treatment of certain
intoxications (e.g.
methanol, phenobarbitone, salicylates) to
decrease renal absorption of the drug or to correct acidosis.
Sodium
bicarbonate reduces stomach acids and can make the urine less acidic. It is
used as an antacid to treat heartburn, indigestion, and other stomach
disorders. It is also used to treat various kidney disorders and to increase
the effectiveness of sulfonamides. Dose:
by slow intravenous injection, a strong
solution (up to 8.4%), or by continuous intravenous infusion, a weaker solution
(usually 1.26%), an amount appropriate to the body base deficit " usually
1-2 mEq/kg "
Contraindications:
Sodium Bicarbonate Injection, USP is
contraindicated in patients who are losing chloride by vomiting or from
continuous gastrointestinal suction, and in patients receiving diuretics known
to produce a hypochloremic alkalosis.
Side effects:
nausea or vomiting; 
headache; 
sever mood changes; 
muscle pain;
swelling of feet, ankles or legs 
decreased appetite; 
unusual tiredness; constipation; dry mouth or increased thirst; or 
increased urination. Overdosage
Symptoms
Metabolic alkalosis, which may be,
accompanied compensatory hyperventilation, paradoxical acidosis of the
cerebrospinal fluid, severe hypokalaemia, hyperirritability or tetany.
Treatment
The
bicarbonate should be stopped and the patient managed according to the degree
of alkalosis present. To control the symptoms of alkalosis the patient should
rebreathe expired air. Sodium chloride injection 0.9% may be given
intravenously, potassium chloride also may be indicated if there is
hypokalaemia.
Calcium gluconate
may be used to control hyperirritability and tetany which can occur in severe
alkalosis. Ammonium chloride may also be indicated as an acidifying agent in
severe cases.
Nursing
considerations:
Laboratory determination of the patient's acid
base status is recommended before and during treatment to minimize the
possibility of overdosage and resultant metabolic alkalosis. The use of scalp veins should be avoided.
Do not use the injection if it contains
precipitate. Do not use unless the solution is clear and the container and seal
are intact. Discard any unused portion
