Sodium Bicarbonate

Provider Level

AEMT/RN/Paramedic

Class

Alkalinizing agent, electrolyte

Mechanism of Action

Buffers excess hydrogen ions to increase blood pH, reverses metabolic acidosis, and promotes urinary alkalinization to assist in the excretion of certain toxins.

Indications

Severe metabolic acidosis, tricyclic antidepressant (TCA) overdose, hyperkalemia, crush syndrome.

Contraindications

Metabolic or respiratory alkalosis, hypocalcemia, hypokalemia, hypernatremia, severe pulmonary edema.

Routes

IV, IO

Onset / Duration

Onset: 2 to 10 minutes. Duration: 1 to 2 hours.

Adverse Effects

Metabolic alkalosis, hypernatremia, hypokalemia, hypocalcemia, paradoxical intracellular acidosis, severe tissue necrosis if extravasated.

Precautions & Interactions

Requires adequate ventilation to eliminate the carbon dioxide produced during buffering. Do not mix directly with calcium chloride or catecholamines as it may cause precipitation or inactivation. Flush IV lines well before and after administration.

Special Considerations

Not recommended for routine use in cardiac arrest unless a specific indication such as hyperkalemia, TCA overdose, or known severe pre-existing metabolic acidosis is suspected. Monitor the IV site closely for extravasation.