Sodium bicarbonate is no longer a first-line drug, because it worsens acidosis when administered in the presence of inadequate ventilation and perfusion. It is administered only after epinephrine administration has not improved a clinical situation. An initial dose of 1 meq/kg IV is given only after the airway has been secured, the patient hyperventilated, and CPR initiated. An exception may be a situation where hyperkalemia is a factor, and where metabolic acidosis is severe. Resuscitation drugs are ineffective in the face of severe acidosis and severe alkalosis. In neonates or premature infants, sodium bicarbonate should be diluted 1:1 with sterile water, not saline. Indications for bicarbonate use are the same as for adults.
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