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Sodium Bicarbonate Bicarb – CC Meds

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A quick review the medication Sodium Bicarbonate, aka Bicarb.

Stop it all right in this lesson here we’re going to be talking about sodium bicarbonate commonly referred to as bicarb so bicarb has a history that’s really long-standing history going back to 1791 when a french chemist actually made the first sodium carbonate then kind of fast forward from there our first use of iv sodium bicarbonate was actually in the 1950s

And today it’s now considered one of the essential medications according to the world health organization so bicarb is the most widely used buffering agent for treatment of persistent metabolic acidosis due to a prolonged low flow state so think hypoperfusion diabetic ketoacidosis lactic acidosis and hyperkalemia the use of this medication increases our plasma

Bicarbonate level and really buffers excess hydrogen ions so our acid concentration thus ultimately raising our patients ph and then reverse the clinical manifestations of acidosis when we look at this medication as a whole there’s a lot of different uses in which it can be used medically non-medically critical care versus not so i’m just going to be covering the

Cases in which we’re typically going to be using this in the icu so first is going to be metabolic acidosis it’s really important that we want to correct this acidosis for our patients in a lot of cases and especially when we’re using vasopressors because those are going to be less effective when they’re in an acidic environment especially a very acidic environment

So less than 7.1 cardiac arrest is another indication so be careful though about just administering this blindly during cardiac arrest because it can actually produce a paradoxical acidosis from co2 production so we typically want to withhold this at least early on in the code unless acidosis is something that’s clearly present for the patient another use would

Be for severe hyperkalemia so typically if our potassium is greater than six and so here this is going to be driving extracellular potassium into the cells lowering our serum potassium levels another uses for diabetic ketoacidosis but this definitely depends on the facility and the provider outcomes are similar to patients though who are treated with or without

Bicarb so whether it’s an effective treatment or not definitely remains up for debate another potential use that you could hear about it or see it is in a hydration protocol prior to contrast injection so again we’ve got conflicting evidence here but there may be some benefit to using bicarb to help to prevent post contrast nephropathy and we can also use bicarb

And certain drug toxicities examples here include aspirin tricyclic antidepressants methanol salicates and barbiturate overdoses now some contraindications for a juice would include patients who have a metabolic or respiratory alkalosis so if they’re already in an alkaline state we don’t want to give them bicarb and push them further that way also patients who have

A loss of chloride from either excessive vomiting or excessive continuous gi suction so here think like your decompression with the og or an ng if they’ve got a significant loss in chloride this might not be a good choice for them and we do want to use it cautiously in people who have renal insufficiency heart failure or other edematis sodium retaining conditions so

Just some quick adverse effects so the first and most obvious one is going to be alkalosis so obviously we are increasing their ph which is creating a more alkaline environment for the patient this can actually cause something we call a left shift and our oxyhemoglobin dissociation curve this can ultimately compromise the release of oxygen to the tissue leading to

Lactic acidosis which kind of works against us and then another adverse effect potentially this medication is edema all right so common concentrations that we can see this typically we’ve got an iv push and an iv infusion iv push is going to be 50 ml equivalents and 50 ml vial this is typically what’s referred to as an amp of bicarb then from there for iv infusions

We can either have have it mixed with fluid so typically like 150 ml equivalents in a liter of fluid or we can have a one-to-one bicarbon fusion so this is 250 ml equivalents and 250 ml so this is typically going to be that bicarbon fusion for the sticker patients that we’re using and then from there are common dosing so iv push typically we’re going to be giving

One amp which is that 50 ml equivalents for iv infusion this can range anywhere from 0.5 to 1 mil equivalents per kilogram per hour for our pharmacokinetics iv administration is going to be immediate onset immediate peak duration is usually about one to two hours or again if we have an infusion for the duration of that infusion and then our plasma concentration

Is actually regulated by the kidneys so we have acidification of the urine if we have a deficit of bicarb so we’re going to get rid of those hydrogen ions out through the urine or through alkalinization of the urine when we have an excess so the kidneys will release bicarbon to the urine causing a more alkaline urine in order to get rid of that excess bicarb and

Then some things for you to consider when you do have a patient that’s getting this medication we want to be avoiding the risk of alkalosis so we want to obtain a blood ph po2 pco2 and serum electrolytes we want to make sure that we’re monitoring our relevant lab values so this could be our potassium our sodium our co2 levels potentially lactate again on our abg

Like i talked about the ph co2 or bicarb level there we do want to monitor the patient closely during our iv administration as fluid or solute overload can actually cause the dilution of serum electrolytes over hydration and thus heart failure and pulmonary edema and then also make sure that you guys don’t administer this in the same line as calcium as a strong

Precipitate wool form and then for lab studies this could potentially increase our sodium and lactate levels so definitely make sure and keep an eye on those it may actually decrease our potassium levels as that ph increases so make sure we’re monitoring that as well and then monitor our serum co2 or on abg our bicarb level as well and so that was our review of

Sodium bicarb hopefully you guys got some good information from this lesson so i hope that you guys found this information useful if you did please leave me a like on the video down below that really helps youtube know to show this video to other people out there as well as leave me a comment down below i love reading the comments that you guys leave and i try

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Transcribed from video
Sodium Bicarbonate "Bicarb" – CC Meds By ICU Advantage