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Sodium Bicarbonate

Presentation

  • Sodium bicarbonate 8.4% (1mmol/mL)
  • 100mL vial

Role

  • Management of cardiotoxicity due to sodium channel blockade in tricyclic antidepressant poisoning.
  • Urinary alkalinisation with sodium bicarbonate enhances the elimination of drugs such as salicylates and chlorophenoxy herbicides in poisonings.
Sodium Bicarbonate
  • ALERT – If there is no response to bicarbonate therapy or the maximum dose is reached, consult a clinical toxicologist through the local toxicology service or Poisons Information Centre 13 11 26 for ongoing management advice.

Dose

Tricyclic antidepressant poisoning with widening of QRS >120ms and terminal R wave in aVR

  • 1 mmol/kg IV bolus q5min titrated to narrowing of the QRS complex, to a maximum dose of 6mmol/kg. Patients should be intubated and hyperventilated at the same time to control pCO2 at 30-35mmHg.

Urinary Alkalinisation for salicylate poisoning

  • 1mmol/kg IV bolus followed by an infusion of 25-50mmol/hour aiming for a urinary pH >7.5. Ensure potassium is maintained > 3.0mmol/L.

Stocking recommendations

Bicarbonate is readily available given it is a standard resuscitation drug.

Disclaimer

Fact sheet developed by Queensland Poisons Information Centre, Updated: July 2020.

This fact sheet is about the use of these antidotes in Australia, and may not apply to other countries. Children’s Health Queensland Hospital and Health Service cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this fact sheet.

CHQ