Bicarbonate infusion

Incompatibilities Do not mix IV minocycline before or during administration with any solutions containing the following Adrenocorticotropic hormone (ACTH), aminophylline, amobarbital sodium, amphotericin B, bicarbonate infusion mixtures, calcium gluconate or chloride, carbenicillin, cephalothin sodium, cefazolin sodium, chloramphenicol succinate, colistin sulfate, heparin sodium, hydrocortisone sodium succinate, iodine sodium, methicillin sodium, novobiocin, penicillin, pentobarbital, phenytoin sodium, polymyxin, prochlorperazine, sodium ascorbate, sulfadiazine, sulfisoxazole, thiopental sodium, vitamin K (sodium bisulfate or sodium salt), whole blood. 

Management of methanol and ethylene glycol poisoning is similar. Symptomatic support of respiration and circulation is augmented by correction of metabolic acidosis with intravenous bicarbonate infusion, and control of seizures with diazepam. Ethanol inhibits the metabolism of methanol and ethylene glycol to the toxic metabolites, and can give time for further treatment. The goal is to maintain blood ethanol concentrations between 100 and 150 mg per decilitre, sufficient to saturate alcohol... 

When overdosing occurs, gastric lavage is advised and an alkaline, high urine output state should be maintained (see Chapter 59 Management of the Poisoned Patient). Hyperthermia and electrolyte abnormalities should be treated. In severe toxic reactions, ventilatory assistance may be required. Sodium bicarbonate infusions may be employed to alkalinize the urine, which will increase the amount of salicylate excreted. 

A 43-year-old man injected a large dose of cocaine in a suicide attempt and had a seizure and cardiopulmonary arrest, from which he was resuscitated. His arterial blood pH was 6.72 and his electrocardiogram showed a wide complex tachycardia. An infusion of sodium bicarbonate maintained the blood pH at 7.50 and the electrocardiogram became normal. The bicarbonate infusion was discontinued after 12 hours. 

Consider the use of bicarbonate infusion in patients with renai insufficiency. 

Bicarbonate infusion to correct acidosis is avoided because it can precipitate a sudden (and potentially fatal) decrease in serum potassium. 

Energy is required for muscular activity, growth, reproduction, and synthesis of metabolites such as proteins, fatty adds, nucleic adds, and steroids, which are essential to maintain basal metabolic functions as well as optimal growth and development. Numerous methods such as the food record, pC]-bicarbonate infusion, and indirect calorimetry have been used to estimate energy expenditure in humans. 

The [ C]-bicarbonate infusion method is invasive and of short duration (<24 hr). Activity of the subject is restricted during the infusion. Therefore,... 

Holstad SG, Perry PJ, Kathol RG, Carson RW, Krummel SJ. The effects of intravenous theophylline infusion versus intravenous sodium bicarbonate infusion on lithium clearance in normal subjects. Psychiatry Res 9ZZ) 25, 203-11. 

Adult dogs Pb acetate, IX i.v., 0.2 or 10 mg/kg, stop-flow analysis Pb-reuptake sites in the renal system Proximal and distal tubular sites were identical proximal tubular reuptake shown with citrate or bicarbonate infusion Victery et al. (1979)... 

A 72-year-old woman, treated with flecainide and haloperidol, presented with breathlessness due to regular tachycardia with wide QRS complex. The ECG showed a regular monomorphic tachycardia at ISObpm, no apparent P wave, QRS duration of 240 ms with a left bxmdle branch block. An intravenous bolus of 10 mg ATP was administered. However, it turned out to be ineffective. The diagnosis of tachycardia induced by flecainide overdose was considered and treatment with 8.4% sodium bicarbonate was initiated. The sodium bicarbonate infusion caused immediate narrowing of the patienPs QRS and the ECG showed sinus rhythm. Blood samples confirmed flecainide overdose [27]. 

Lactic acidosis is associated with high mortality (66). The treatment of lactic acidosis consists of massive bicarbonate infusions with early administration of frusemide or dialysis. Infusion of too much concentrated bicarbonate may lead to hyperosmo-larity (68). Insulin therapy is also important, as many patients have unexpected ketoacidosis (68, 75). Corticoids, vasopressors or methylene blue do not modify the course of lactic acidosis (68). 

Is the arterial pH less than 7.1 If yes, consider administration of sodium bicarbonate 100 to 150 mEq intravenously as slow infusion. Alternatively, consider use of tromethamine intravenously. 

Dextrose and insulin (with or without sodium bicarbonate) are typically given at the time of calcium therapy in order to redistribute potassium into the intracellular space. Dextrose 50% (25 g in 50 mL) can be given by slow IV push over 5 minutes or dextrose 10% with 20 units of regular insulin can be given by continuous TV infusion over 1 to 2 hours. The onset of action for this combination is 30 minutes and the duration of clinical effects... 

The antimony electrode used by Rosenfeldt et al. [156] did respond proportionally to the myocardial pH changes in dogs produced by infusion of sodium bicarbonate or inhalation of carbon dioxide. However, pH measured by the antimony electrodes was consistently about 0.26 units higher than that which was measured with the Paratrend optical... 

Sodium bicarbonate Initiate infusion at 3 ml/kgdiour, beginning 1 hour B-2... 

Infusion of more than 1 L of isotonic (0.9%) sodium chloride may supply more sodium and chloride than normally found in serum, resulting in hypernatremia this may cause a loss of bicarbonate ions, resulting in an acidifying effect. 

Less urgent forms of metabolic acidosis - Sodium bicarbonate injection may be added to other IV fluids. The amount of bicarbonate to be given to older children and adults over a 4- to 8-hour period is approximately 2 to 5 mEq/kg, depending on the severity of the acidosis as judged by the lowering of total CO2 content, blood pH, and clinical condition. Initially, an infusion of 2 to 5 mEq/kg over 4 to 8 hours will produce improvement in the acid-base status of the blood. 

The 250 mg/mL strength is concentrated, and is not for direct IV injection dilute prior to infusion. Do not mix with sodium bicarbonate. Do not mix with other drugs prior to dilution in a suitable IV fluid. 

In Spain a 69-year-old woman with a dilated cardiomyopathy and poor inferior ventricular function developed lactic acidosis after an increase in the dose of buformin (pH 7.1, lactate 18 mmol/1). After withdrawal of buformin and infusion of sodium bicarbonate her renal function and electrolyte disturbances were corrected (61). 

Severe lactic acidosis occurred in a 7-year-old child with osteogenesis imperfecta during short-term (150 minutes) propofol infusion anesthesia (mean infusion rate 13.5 mg/kg/hour) (949). The peak arterial lactate concentration occurred 160 minutes after withdrawal of propofol (lactate 9.2 mmol/1, bicarbonate 16 mmol/1, base deficit 8.3 mmol/1). The hyperlactatemia settled within 18 hours. 

Thus the drop in ammonia content of plasma in alkalosis may be related to the pH effect on urea synthesis rather than to the alterations in permeability caused by changes in pNHs. The treatment of hepatic coma by acidification with C02 would lower pH, inhibiting synthesis of urea. This would cause a rise in blood ammonia. The same type of change could be brought about by infusion of HC1, which would have a double effect on urea synthesis by lowering both pH and bicarbonate. It does not appear necessary to invoke a penetration hypothesis to explain the... 

The stability of procainamide in glucose infusions may be improved by the addition of sodium bicarbonate. Patients receiving sodium chloride infusions of procainamide are prone to the risk of heart failure due to sodium load.121122 Quinidine gluconate is incompatible with intravenous infusion sets made of PVC due to drug loss by adsorption.123... 

Cisplatin Cisplatin is incompatible and should not be mixed with infusions of bisulfite preservatives, sodium bicarbonate, fluorouracil, mannitol and potassium chloride, thiotepa, and aluminum containers. Cisplatin is unstable in sodium chloride solutions and concentrated forms.208,209... 

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