Sodium Carbonate

Provider Level

AEMT/RN/Paramedic

Class

Alkalizing agent, electrolyte

Mechanism of Action

Buffers excess hydrogen ions to raise blood pH, reducing severe metabolic acidosis and facilitating the renal excretion of certain acidic toxins. It also shifts potassium into cells in hyperkalemia.

Indications

Severe metabolic acidosis, tricyclic antidepressant (TCA) toxicity, hyperkalemia, prolonged cardiac arrest with suspected preexisting acidosis.

Contraindications

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

Routes

IV, IO

Onset / Duration

Onset: 2 to 10 minutes. Duration: 1 to 2 hours depending on clinical status.

Adverse Effects

Metabolic alkalosis, hypernatremia, hypokalemia, hypocalcemia, fluid overload, tissue necrosis if extravasation occurs.

Precautions & Interactions

Inadequate ventilation can worsen intracellular acidosis as bicarbonate buffers into carbon dioxide. Flush the IV/IO line thoroughly before and after administration, especially if other drugs are being used. Ensure patent venous access to prevent severe tissue necrosis.

Special Considerations

Authorized for AEMT, RN, and Paramedic levels. Do not mix in the same IV line with calcium preparations (e.g., Calcium Chloride or Calcium Gluconate) as it will precipitate and form chalk-like substances. It may also inactivate catecholamines like epinephrine if given simultaneously without flushing.