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Download Drug Therapy Protocols: Sodium bicarbonate 8.4%
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Drug Therapy Protocols: Sodium bicarbonate 8.4% Disclaimer and copyright ©2016 Queensland Government All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner. The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering ambulance services for, and on behalf of, the QAS. Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents. While effort has been made to contact all copyright owners this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome, please forward to: [email protected] Date October, 2016 Purpose Scope Author To ensure a consistent procedural approach to Sodium bicarbonate 8.4% administration. Applies to all QAS clinical staff. Clinical Quality & Patient Safety Unit, QAS Review date October, 2018 URL https://ambulance.qld.gov.au/clinical.html This work is licensed under the Creative Commons This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Sodium bicarbonate 8.4% October, 2016 Drug class Contraindications Alkalising agent UNCONTROLLED WHEN PRINTED Pharmacology Sodium bicarbonate 8.4% is a hypertonic solution that acts as a buffer. Excess hydrogen ions react with bicarbonate resulting in the formation of carbon dioxide and water. This action assists in restoring plasma pH to within normal ranges.[1–3] Metabolism • Nil Precautions UNCONTROLLED WHEN PRINTED • Nil Metabolised to CO2 and H2O.[1] Indications • Cardiac arrest: Side effects • Cerebral oedema • Congestive heart failure UNCONTROLLED WHEN PRINTED - secondary to suspected hyperkalaemia (e.g. chronic renal failure) - secondary to tricyclic antidepressant (TCA) overdose Presentation • Significant injury with potential for crush syndrome • TCA overdose with QRS > 0.12 OR attributed seizure activity • Vial, 100 mL sodium bicarbonate 8.4% UNCONTROLLED WHEN PRINTED • Suspected hyperkalaemia (with QRS widening AND/OR AV dissociation) Onset (IV) Duration (IV) Half-life Immediate Variable Variable Figure 4.51 QUEENSLAND AMBULANCE SERVICE 891 Sodium bicarbonate 8.4% October, 2016 Schedule Adult dosages • Unscheduled. UNCONTROLLED WHEN PRINTED • Cardiac arrest Intraosseous injection (IO) CCP CCP Intravenous injection (IV) ECP Routes of administration - secondary to suspected hyperkalaemia (e.g. chronic renal failure) - secondary to TCA overdose • Significant injury with potential for crush syndrome • Suspected hyperkalaemia (with QRS widening AND/OR UNCONTROLLED WHEN PRINTED • Sodium bicarbonate 8.4% administration is not indicated in the newly born pre-hospital resuscitation. CCP • Care must be taken to avoid extravasation into tissues as necrosis may occur. IV ECP – QAS Clinical Consultation and Advice Line approval required in all situations. 100 mL. Single dose only. CCP Special notes ECP AV dissociation) IO 100 mL. Single dose only. UNCONTROLLED WHEN PRINTED • The Phebra branded sodium bicarbonate vials are unable to be spiked with QAS supplied Alaris® giving sets. TCA overdose with QRS > 0.12 OR attributed seizure activity • All cannulae and IV lines must be flushed thoroughly with sodium chloride 0.9% before and following each CCP using a 50 mL syringe and 19G drawing up needle. ECP All medication must be withdrawn and administered IV ECP – QAS Clinical Consultation and Advice Line approval required in all situations. 100 mL Repeated every 5 minutes. Total maximum dose 300 mL. UNCONTROLLED WHEN PRINTED • All parenteral medications must be prepared in an aseptic manner. The rubber stopper of all vials must be disinfected with a 2% Chlorhexidine/70% Isopropyl Alcohol swab CCP medication administration. IO 100 mL Repeated every 5 minutes. Total maximum dose 300 mL. and allowed to dry prior to piercing. QUEENSLAND AMBULANCE SERVICE 892 Sodium bicarbonate 8.4% Paediatric dosages UNCONTROLLED WHEN PRINTED • Cardiac arrest - secondary to suspected hyperkalaemia (e.g. chronic renal failure) - secondary to TCA overdose • Significant injury with potential for crush syndrome • Suspected hyperkalaemia (with QRS widening AND/OR UNCONTROLLED WHEN PRINTED CCP ECP AV dissociation) IV ECP – QAS Clinical Consultation and Advice Line approval required in all situations. 1 mL/kg Single dose only. CCP UNCONTROLLED WHEN PRINTED IO 1 mL/kg Single dose only. UNCONTROLLED WHEN PRINTED 894 QUEENSLAND AMBULANCE SERVICE 893
