Review appropriate monitoring for patients receiving sodium bicarbonate. Outline interprofessional team strategies for improving sodium bicarbonate toxicity monitoring. Under arrhythmias and cardiovascular instability, sodium bicarbonate can be administered to adults at 4 to 8 hour IV infusions. Each dose should be monitored and planned in a standard protocol to help evaluate the degree of response expected and predicted to understand the necessity to advance further infusions or withhold administration, given its fluid overloading effects.
Nebulized sodium bicarbonate is an excellent option to treat chemical injuries resulting from chlorine gas, especially within the pulmonary mucosa. The belief is that the inhaled gas neutralizes when it reacts with water and bicarbonate within the respiratory system. After administration, intravenous sodium bicarbonate dissociates to form sodium Na and bicarbonate HCO3.
Bicarbonate anions can consume hydrogen ions H and subsequently convert to carbonic acid H2CO3. Carbonic acid subsequently converts to water H2O and carbon dioxide CO2 for excretion from the lungs.
The main therapeutic effect of sodium bicarbonate administration is increasing plasma bicarbonate levels, which are known to buffer excess hydrogen ion concentration, thereby raising solution pH to combat clinical manifestations of acidosis. Bicarbonate is often a standard element of body fluids and is often regulated by the kidney via secretion or absorption methods to counter-regulate changes in serum pH. This action often leads to its second administration as it is known to alkalinize the urine, capable of changing precipitants in urine and providing a means of normalizing tubular acid concentration gradients to manage high fluctuations in serum acid-base status changes.
This alkalization process enables compounds that would normally precipitate in the renal tubules in acidic conditions to be buffered within the renal tubule, thereby preventing mechanical or chemical damage while also providing increased efficiency within the kidney tubules to excrete acidified substances without disrupting the electrochemical gradient.
One mg tablet of NaHCO3 has 7. Cardiac arrest: Currently, routine bicarbonate administration for cardiac arrest is no longer a recommendation. It should only be administered for cardiac arrest due to hyperkalemia or tricyclic antidepressant overdose, or metabolic acidosis.
Sodium bicarbonate should ideally be given after adequate alveolar ventilation and the initiation of cardiac compressions. Acute metabolic acidosis: If pH is less than 7. Chronic metabolic acidosis: 50 to mEq oral tablet can be initiated and titrated according to the ongoing evaluation of acid-base balance. Lactic acidosis: The use of sodium bicarbonate remains controversial but is an option if pH is below 7.
Diabetic ketoacidosis: The use of sodium bicarbonate remains controversial in diabetic ketoacidosis since recovery outcome is similar with or without NaHCO3. However, sodium bicarbonate is still recommended if the pH is below 7 after 1 hour of fluid administration.
Sodium bicarbonate should be given in hypotonic fluid every two hours until pH is at least 7. The dose needed is empirical and is unpredictable. More can be given if acidosis does not correct with this regimen.
Sodium bicarbonate administration can be at varying doses for renal tubular acidosis, and to achieve urine alkalization, it can be given IV for some intoxications such as salicylate overdose and as a preventative measure against contrast-induced nephropathy.
Administration and extravasation of sodium bicarbonate have been known to cause chemical cellulitis due to its basic properties and have resulted in tissue necrosis, ischemia, and tissue death at administration sites.
In large dose administrations, it is known to increase edema and is more commonly noted in those with renal insufficiency, given its clearance via the kidneys. Drug information provided by: IBM Micromedex. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Keep from freezing. With intravenous use in adults. For continuous intravenous infusion a weaker solution of 1. Sodium bicarbonate may affect the stability or absorption of other drugs if administered at the same time. If possible, allow 1—2 hours before administering other drugs orally. Oral solutions of sodium bicarbonate are required occasionally; these are available from 'special-order' manufacturers or specialist importing companies; the strength of sodium bicarbonate should be stated on the prescription.
Usual strength Sodium bicarbonate 1. Patients or carers should be given advice on the administration of sodium bicarbonate oral medicines. Forms available from special-order manufacturers include: capsule, oral suspension, oral solution, solution for injection, liquid, mouthwash. Other drugs classified as bicarbonate. By mouth For Adult 4. By slow intravenous injection, or by intravenous infusion For Adult Administer an amount appropriate to the body base deficit, to be given by slow intravenous injection of a strong solution up to 8.
To the ear For Child consult product literature.
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