Intravenous sodium bicarbonate

Intravenous sodium bicarbonate
Clinical data
Trade names many
AHFS/Drugs.com Monograph
Pregnancy
category
  • US: C (Risk not ruled out)
Routes of
administration		 intravenous
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability 100% (intravenous)
Identifiers
Synonyms sodium hydrogen carbonate, monosodium carbonate
CAS Number
PubChem CID
DrugBank
ChemSpider
  • none
Chemical and physical data
Formula CHNaO3
Molar mass 84.01 g/mol
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Intravenous sodium bicarbonate, also known as sodium hydrogen carbonate, is a medication primarily used to treat severe metabolic acidosis.[1] For this purpose it is generally only used when the pH is less than 7.1 and when the underlying cause is either diarrhea, vomiting, or the kidneys.[2] Other uses include high blood potassium, tricyclic antidepressant overdose, and cocaine toxicity as well as a number of other poisonings.[1][3][4]It is given by injection into a vein.[2]

Side effects may include low blood potassium, high blood sodium, and swelling.[1][4] It is not recommended in people with low blood calcium. Sodium bicarbonate is in the alkalinizing family of medication. It works by increasing blood bicarbonate, which buffers excess hydrogen ion and raises blood pH.[5]

Commercial production of sodium bicarbonate began between 1791 and 1823.[6] Intravenous medical use began around the 1950s.[4] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] Sodium bicarbonate is available as a generic medication.[5] The wholesale cost in the developing world is about 0.09 to 2.58 USD per 10 ml of 8.4% solution.[8] In the United Kingdom this amount costs the NHS about 11.10 pounds.[2]

Medical uses

Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosis, such as can occur in, for example, severe renal disease, diabetic ketoacidosis, circulatory insufficiency, extracorporeal circulation of blood, in hemolysis requiring alkalinization of the urine to avoid nephrotoxicity of blood pigments, and certain drug intoxications, such as by barbiturate overdose, salicylate poisoning, tricyclic antidepressant overdose or methanol poisoning.[9] In addition, sodium bicarbonate is indicated in severe diarrhea, where large amounts of bicarbonate may be lost.[9] However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin in case of diabetic ketoacidosis.[9]

Contraindications

Intravenous sodium bicarbonate is contraindicated in patients who are losing chloride, such as by vomiting.[9]

Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with congestive heart failure and severe renal insufficiency, where low sodium intake is strongly indicated to prevent sodium retention.[9] By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids.[9]

Side effects

Extravasation of intravenous sodium bicarbonate has been reported to cause chemical cellulitis because of its alkalinity, resulting in tissue necrosis, ulceration and/or sloughing at the site of infiltration. This condition is managed by prompt elevation of the part, warmth and local injection of lidocaine or hyaluronidase.[9]

Interactions

Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution.[9]

Intravenous sodium bicarbonate should not be mixed with calcium, as they may precipitate, except where compatibility has been previously established for the preparations at hand.[9]

Overdosing

Overdose of intravenous sodium bicarbonate results in solute and/or fluid overload, potentially leading to edema, including pulmonary edema.[9] Also, it can cause metabolic alkalosis (with signs including muscular twitchings, irritability and tetany).[9] Hypernatremia is also possible.[9] Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing.[9]

Rapid administration (equal to or exceeding 10 mL/min) of intravenous sodium bicarbonate into neonates and children under two years of age may produce hypernatremia, resulting in a decrease in cerebrospinal fluid pressure and, possibly, intracranial hemorrhage. Therefore, the rate of administration to such patients should not exceed 8 mEq/kg/day, unless a very strong indication is present.[9]

Composition

It is administered as a hypertonic solution of sodium bicarbonate, most commonly in concentrations of 4.2%, 5.0%, 7.5% or 8.4%.[9]

The solutions generally contain no antimicrobial agent or other added buffer.[9]

Mechanism of action

After injection, intravenous sodium bicarbonate dissociates to provide sodium (Na+) and bicarbonate (HCO3−) anions. Bicarbonate anions can consume hydrogen ions (H+) and thereby be converted to carbonic acid (H2CO3), which can subsequently be converted to water (H2O) and carbon dioxide (CO2) which can be excreted by the lungs.[9]

References

  1. 1 2 3 WHO Model Formulary 2008 (PDF). World Health Organization. 2009. p. 489-492. ISBN 9789241547659. Retrieved 8 January 2017.
  2. 1 2 3 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 684. ISBN 9780857111562.
  3. ↑ Bruccoleri, RE; Burns, MM (March 2016). "A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening.". Journal of medical toxicology : official journal of the American College of Medical Toxicology. 12 (1): 121–9. PMID 26159649.
  4. 1 2 3 Dart, Richard C. (2014). Medical Toxicology. Lippincott Williams & Wilkins. p. 257. ISBN 9780781728454.
  5. 1 2 "Sodium Bicarbonate". The American Society of Health-System Pharmacists. Retrieved 8 January 2017.
  6. ↑ Ihde, Aaron J. (1970). The Development of Modern Chemistry. 447: Courier Corporation. ISBN 9780486642352.
  7. ↑ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016.
  8. ↑ "Sodium Bicarbonate". International Drug Price Indicator Guide. Retrieved 8 December 2016.
  9. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Sodium Bicarbonate, Dosage Form: injection, solution from Drugs.com. Revised: 03/2011 by General Injectables & Vaccines, Inc.
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