Description and indication for use

Alkalinising agent used in the treatment of metabolic acidosis due to bicarbonate loss from kidneys and GI tract or following prolonged resuscitation (may be associated with lactic acidosis).

Dose

To correct metabolic acidosis

Give HALF the mmol deficit, then review.

mmol deficit = Base excess x Weight (kg).

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Reconstitution/Dilution

Ampoule = sodium bicarbonate 8.4% (1 mmol/mL).

IV:

Dilute 1:1 with water for injection (0.5 mmol/mL = 4.2%) ie 1 mL of water for injection for every 1 mL of Sodium Bicarbonate 8.4% solution.

This is the maximum concentration to be used, 8.4% solution is extremely irritant to vessels and tissues. May be further diluted if necessary.

Route and method of administration

Do not administer via arterial (umbilical or peripheral) catheter.

IV:

Give slowly over 15 to 30 minutes.

Rapid IV administration is not recommended

May cause sudden osmolar shifts and has been associated with IVH.

Side effects

May cause hypernatraemia with repeated doses.

Rapid administration has been associated with IVH.

Extravasation causes tissue necrosis.

Contraindications

Do not administer via arterial (umbilical or peripheral) catheter.

CAUTION in hypernatraemia (solution contains sodium 1 mmol/mL).

Nursing responsibilities

Observe for signs of extravasation.

Observe routine electrolytes to ensure serum sodium is within normal range.

Compatibility Information

IMPORTANT: Contact Pharmacy for drugs not appearing in the table below. Uncommon drugs have simply been omitted and may be incompatible.

Compatible

Incompatible

Fluids

Glucose 5%, Sodium Chloride 0.9%.

Intralipid, TPN.

Drugs

Amikacin, Aminophylline, Amphotericin B, Atropine Sulphate, Ceftazidime, Cephalothin, Clindamycin, Erythromycin, Flucloxacillin, Frusemide, Heparin Sodium, Hydrocortisone Sodium Succinate, Phenobarbitone, Phenytoin, Verapamil.

Adrenaline, Amiodarone, Amoxycillin, Benzylpenicillin, Calcium, Cefotaxime, Ciprofloxacin, Dobutamine, Dopamine, Imipenem-Cilastatin, Insulin (Neutral), Isoprenaline, Magnesium, Midazolam, Morphine Sulphate, Noradrenaline, Potassium, Suxamethonium, Thiopentone, Ticarcillin-Clavulanate, Vancomycin.

Y-Site

For up to 3 hours: Insulin (Neutral), Morphine Sulphate.

For up to 4 hours: Aciclovir, Ceftriaxone, Heparin, Piperacillin-Tazobactam, Vancomycin.