Intravenous sodium bicarbonate
Encyclopedia
Intravenous sodium bicarbonate (trade names including Baros) is a solution for intravenous administration that increases plasma bicarbonate
, buffer
s excess hydrogen ion
concentration, raises blood pH and reverses the clinical manifestations of acidosis
.
, most commonly in concentrations of 4.2%, 5.0%, 7.5% or 8.4%.
The solutions generally contain no antimicrobial agent or other added buffer.
(H2CO3), which can subsequently be converted to water (H2O) and carbon dioxide (CO2) which can be excreted by the lung.
, 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 or methanol poisoning. In addition, sodium bicarbonate is indicated in severe diarrhea
, where large amounts of bicarbonate may be lost. However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin
in case of diabetic ketoacidosis
.
, such as by vomiting.
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. By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids.
, including pulmonary edema
. Also, it can cause metabolic alkalosis
(with signs including muscular twitchings, irritability
and tetany
). Hypernatremia
is also possible. Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing.
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.
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.
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
.
Bicarbonate
In inorganic chemistry, bicarbonate is an intermediate form in the deprotonation of carbonic acid...
, buffer
Buffer
Buffer may refer to:*Buffer state, a country lying between two potentially hostile greater powers, thought to prevent conflict between them* Buffer zone, any area that keeps two or more other areas distant from one another, may be demilitarized...
s excess hydrogen ion
Hydrogen ion
Hydrogen ion is recommended by IUPAC as a general term for all ions of hydrogen and its isotopes.Depending on the charge of the ion, two different classes can be distinguished: positively charged ions and negatively charged ions....
concentration, raises blood pH and reverses the clinical manifestations of acidosis
Acidosis
Acidosis is an increased acidity in the blood and other body tissue . If not further qualified, it usually refers to acidity of the blood plasma....
.
Composition
It is administered as a hypertonic solution of sodium bicarbonateSodium bicarbonate
Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...
, most commonly in concentrations of 4.2%, 5.0%, 7.5% or 8.4%.
The solutions generally contain no antimicrobial agent or other added buffer.
Mechanism of action
After injection, intravenous sodium bicarbonate dissociates to provide sodium (Na+) and bicarbonate (HCO3-) anions. Bicarbonate anions can consume hydrogen inons (H+) and thereby be converted to carbonic acidCarbonic acid
Carbonic acid is the inorganic compound with the formula H2CO3 . It is also a name sometimes given to solutions of carbon dioxide in water, because such solutions contain small amounts of H2CO3. Carbonic acid forms two kinds of salts, the carbonates and the bicarbonates...
(H2CO3), which can subsequently be converted to water (H2O) and carbon dioxide (CO2) which can be excreted by the lung.
Indications
Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosisMetabolic acidosis
In medicine, metabolic acidosis is a condition that occurs when the body produces too much acid or when the kidneys are not removing enough acid from the body. If unchecked, metabolic acidosis leads to acidemia, i.e., blood pH is low due to increased production of hydrogen by the body or the...
, such as can occur in, for example, severe renal disease, diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
, circulatory insufficiency, extracorporeal circulation of blood, in hemolysis
Hemolysis
Hemolysis —from the Greek meaning "blood" and meaning a "loosing", "setting free" or "releasing"—is the rupturing of erythrocytes and the release of their contents into surrounding fluid...
requiring alkalinization of the urine to avoid nephrotoxicity
Nephrotoxicity
Nephrotoxicity is a poisonous effect of some substances, both toxic chemicals and medication, on the kidneys. There are various forms of toxicity. Nephrotoxicity should not be confused with the fact that some medications have a predominantly renal excretion and need their dose adjusted for the...
of blood pigments, and certain drug intoxications, such as by barbiturate overdose
Barbiturate overdose
A barbiturate overdose results when a person takes a larger-than-prescribed dose of barbiturates. Symptoms of an overdose typically include sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgment, drowsiness, shallow breathing, and staggering. In severe cases, coma...
, salicylate poisoning or methanol poisoning. In addition, sodium bicarbonate is indicated in severe diarrhea
Diarrhea
Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...
, where large amounts of bicarbonate may be lost. However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
in case of diabetic ketoacidosis
Diabetic ketoacidosis
Diabetic ketoacidosis is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances...
.
Contraindications
Intravenous sodium bicarbonate is contraindicated in patients who are losing chlorideChloride
The chloride ion is formed when the element chlorine, a halogen, picks up one electron to form an anion Cl−. The salts of hydrochloric acid HCl contain chloride ions and can also be called chlorides. The chloride ion, and its salts such as sodium chloride, are very soluble in water...
, such as by vomiting.
Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with congestive heart failure
Congestive heart failure
Heart failure often called congestive heart failure is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. Heart failure can cause a number of symptoms including shortness of breath, leg swelling, and exercise intolerance. The condition...
and severe renal insufficiency, where low sodium intake
Low sodium diet
A low sodium diet is a diet that includes no more than 1,500 to 2,400 mgs of sodium per day. People who follow a vigorous or moderate exercise schedule are usually advised to limit their sodium intake to 3,000 mg per day and those with moderate to severe heart failure are usually advised to...
is strongly indicated to prevent sodium retention. By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids.
Overdosing
Overdose of intravenous sodium bicarbonate results in solute and/or fluid overload, potentially leading to edemaEdema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
, including pulmonary edema
Pulmonary edema
Pulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
. Also, it can cause metabolic alkalosis
Metabolic alkalosis
Metabolic alkalosis is a metabolic condition in which the pH of tissue is elevated beyond the normal range . This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate, or alternatively a direct result of increased bicarbonate concentrations.-Terminology:*Alkalosis...
(with signs including muscular twitchings, irritability
Irritability
Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration....
and tetany
Tetany
Tetany has two meanings, though both are related to the muscular system.* Tetany * Tetany The terms "tetany" and "tetanus" are distinct....
). Hypernatremia
Hypernatremia
Hypernatremia or hypernatraemia is an electrolyte disturbance that is defined by an elevated sodium level in the blood. Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body...
is also possible. Repeated fractional doses and frequent monitoring by laboratory tests are recommended to minimize the possibility of overdosing.
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
Hypernatremia
Hypernatremia or hypernatraemia is an electrolyte disturbance that is defined by an elevated sodium level in the blood. Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body...
, resulting in a decrease in cerebrospinal fluid pressure and, possibly, intracranial hemorrhage
Intracranial hemorrhage
An intracranial hemorrhage is a hemorrhage, or bleeding, within the skull.-Causes:Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma or nontraumatic causes such as a ruptured aneurysm...
. Therefore, the rate of administration to such patients should not exceed 8 mEq/kg/day, unless a very strong indication is present.
Interactions
Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution.Intravenous sodium bicarbonate should not be mixed with calcium
Calcium
Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
, as they may precipitate
Precipitation (chemistry)
Precipitation is the formation of a solid in a solution or inside anothersolid during a chemical reaction or by diffusion in a solid. When the reaction occurs in a liquid, the solid formed is called the precipitate, or when compacted by a centrifuge, a pellet. The liquid remaining above the solid...
, except where compatibility has been previously established for the preparations at hand.
Other adverse reactions
ExtravasationExtravasation
Extravasation is the accidental administration of intravenously infused medicinal drugs into the surrounding tissue, either by leakage , or direct exposure...
of intravenous sodium bicarbonate has been reported to cause chemical cellulitis because of its alkalinity, resulting in tissue necrosis
Necrosis
Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...
, ulceration
Ulceration
Ulceration may refer to:-In medicine:*Ulcer , a discontinuity of the skin or a break in the skin that stops it from continuing its normal functions*Corneal ulcer, an inflammatory or infective condition of the cornea...
and/or sloughing
Sloughing
Sloughing may refer to the act of shedding or casting off dead tissue, such as cells of the endometrium, shed during menstruation. It may also refer to the process where necrotic surface epithelial cells are discarded from the small intestinal mucosa following various infections which may occur...
at the site of infiltration. This condition is managed by prompt elevation of the part, warmth and local injection of lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
or hyaluronidase
Hyaluronidase
The hyaluronidases are a family of enzymes that degrade hyaluronic acid.In humans, there are six associated genes, including HYAL1, HYAL2, HYAL3, and PH-20/SPAM1.-Use as a drug:...
.
External links
- Intravenous sodium bicarbonate at Drugs.com, with more detailed dosages