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Drug Therapy Protocols: Sodium bicarbonate 8.4%
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This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
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 All medication must be withdrawn and administered using a 50 mL syringe and 19G drawing up needle.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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