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Sodium Bicarbonate in Severe Metabolic Acidosis

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Sodium Bicarbonate in Severe Metabolic Acidosis

  • See Also
  1. Sodium Bicarbonate
  • Efficacy
  1. No evidence that Sodium Bicarbonate improves outcomes
  2. Treat acidosis with ventilation and perfusion
  3. May impair Cardiac Function
  • Indications
  1. See Sodium Bicarbonate for dosing in Cardiac Arrest
  2. Documented severe Metabolic Acidosis associated with:
    1. Unstable hemodynamic state
    2. Arterial pH <6.9 to 7.0
  3. Example:
    1. Diabetic Ketoacidosis with Arterial pH <6.9
  • Precautions
  1. Observe for Hypokalemia
  2. Do not over-correct pH
  3. Adequate ventilation and perfusion are critical
  • Dosing
  • Adults (if arterial pH <6.9 to 7.0)
  1. Sodium Bicarbonate 1 amp (50 meq or 100 mmol)
  2. Dilute in 400 ml sterile water
  3. Administer at 200 ml/hour
    1. Dose full bag or 400 cc of 50 meq if pH <6.9
    2. Dose half bag or 200 cc of 25 meq if pH 6.9 - 7.0
  4. If arterial pH <6.9 on recheck in 2 hours
    1. May repeat dosing as above
  • Dosing
  • Children (if arterial pH <7)
  1. Prepare solution to replace 1-2 meq/kg
  2. Solution should contain <0.5 meq/ml bicarbonate
  3. Dilute with appropriate Saline Solution
    1. Sodium should be <155 meq/L (NS concentration)
    2. Every bicarb ampule contains 2000 meq/L Sodium
  4. Limit infusion rate to <1 meq/kg/hour bicarbonate
  5. Example: 20 kg child with arterial pH <6.9
    1. Maximum replacement is 40 meq bicarbonate
    2. Dilute 40 ml NaHCO3 in 500 cc in 1/4 NS
      1. Contains 40 meq Na + 38 meq Na = 78 meq Na
      2. Sodium concentration is 156 meq/L (same as NS)
    3. Limit this 20 kg child's rate to 20 meq/hour
      1. This child's rate should be <250 cc/hour