Reasons for needing a sodium bicarbonate (bicarb) drip are discussed in excellent posts by Pulm Crit and LITFL. One can be made by mixing the following:
Mixing
- 1 liter D5W, remove 150 ml from bag
- 3 ampules of 8.4% NaHCO3 (50 mEq each in 50 ml), inject each into the D5W bag
Indication
- Mixing the infusion above yields 150 mEq/L at 300 mOsmol, which is slightly higher than serum concentrations.
- Infuse 1 liter @ 200 ml/hr (urine alkalinization) up 1 L/hr (cardiac arrest with poor pressors response), depending on indication.
Further Reading
Acid-Base Disturbances: An Emergency Department Approach Date Release: Jun 2020 Acid-base disturbances signal many disorders and diseases, and interpretation of testing results can be difficult. Using descriptive methodologies, comparing various approaches, and following a diagnostic algorithm will improve diagnosis and treatment.
Calcium Channel Blocker and Beta Blocker Overdose, and Digoxin Toxicity Management – Pharmacology EXTRA Supplement (Pharmacology CME) Date Release: Sep 2020 This Pharmacology EXTRA CME supplement (free to Emergency Medicine Practice subscribers) provides an evidence-based overview of emergency department management of calcium-channel blocker overdose, beta blocker overdose, and digoxin toxicity, and focuses on the caveats of treatment for each.
References
Last Updated on January 25, 2023
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
