Sodium Bicarbonate Therapy

Indications for sodium bicarbonate therapy include QRS complex widening greater than 100 ms, hypotension refractory to fluid hydration, and ventricular dysrhythmias. Sodium bicarbonate has been shown to improve conduction, increase contractility, and suppress ventricular ectopy. It is given as an initial bolus of 1 to

2 meq/kg, which can be repeated until patient improvement is noted or until blood pH equals 7.50 to 7.55 ( Fig 152-4). Alkalinization beyond this point can be deleterious and therefore is discouraged. Continuous infusions of sodium bicarbonate are usually administered as 3 ampules (50 meq/50 mL) placed in 1 L of 5% D/W or 2 ampules added to 5% D/0.45 NS (slightly hypertonic with NaHCO 3 added) solution and run at a rate of 2 to 3 cc/kg/h. Adjustments in the intravenous rate are made based on blood pH measurements, serum sodium level, and clinical response to therapy. Hypokalemia is an expected complication of NaHCO 3 therapy. Intravenous potassium supplementation is usually required, and serum potassium levels should be measured frequently.

FIG. 152-4. A. Cardiac rhythm strip of a patient with a wide QRS, recorded 3 h after ingesting amitriptyline. B. Narrowing of the QRS complex in same patient after receiving an intravenous bolus of sodium bicarbonate.

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