Indication
Management of acidosis in cardiac arrest.?ÿManagement of metabolic acidosis in:
Severe renal disease
Uncontrolled diabetes
Circulatory insufficiency from shock or dehydration
Severe primary lactic acidosis
Alkalinization of urine.
Pharmacology
Sodium bicarbonate is a systemic alkalinizing agent. It increases plasma bicarbonate, buffers excess hydrogen ion concentration, and raises blood pH, thereby reversing the clinical manifestations of acidosis. It can also be used to replenish electrolyte imbalance as a treatment adjunct for severe diarrhea where the loss of bicarbonate can be significant.
Dosage
Oral: The usual dose is 300 mg to 2 grams, 1 to 4 times daily.Intravenous (Severe metabolic acidosis):
Adult: By slow inj of a hypertonic solution of up to 8.4% (1000 mmol/L), or by continuous infusion of a weaker solution, usually 1.26% (150 mmol/L). For correction of acidosis during advanced cardiac life support procedures, 50 ml of an 8.4% solution may be given.
Elderly: Dosage adjustments may be required.
Interaction
This medication has the potential to interact with many medications. Should not take any other medication within 1 to 2 hours of taking an antacid. Potentially hazardous interactions with Corticosteroids and Corticotropin, Alkalis, Calcium, Diuretics and Potassium.
Contradiction
This drug is contraindicated in hypoventilatory states, chloride depletion owing to continuous gastric fluid loss, metabolic and/or respiratory alkalosis, hypocalcemia and diuretics known to produce hypochloremic alkalosis.
Side Effect
This medication is generally well tolerated. However, high doses may cause headache, nausea or irritability. If any of these effects continue or become bothersome, inform your doctor. Notify your doctor if you develop: muscle weakness, slow reflexes, confusion, swelling of the feet or ankles, black tar-like stools, coffee-ground vomit. If you notice other effects not listed above, contact your doctor or pharmacist.
Pregnancy
Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Precaution
Pre-existing heart disease, kidney disease, liver disease, high blood pressure, any allergies.
Overdose
If alkalosis results, the bicarbonate should be stopped and the patient managed according to the degree of alkalosis present. 0.9% sodium chloride injection intravenous may be given; potassium chloride also may be indicated if there is hypokalemia. Severe alkalosis may be accompanied by hyperirritability or tetany and these symptoms may be controlled by calcium gluconate. An acidifying agent such as ammonium chloride may also be indication in severe alkalosis.
Storage
Store in a cool & dry place protected from light. Keep out of reach of children.