Hypertonic sodium bicarbonate

Neonates and children (younger than 2 years of age) - Rapid injection (10 mL/min) of hypertonic sodium bicarbonate solutions may produce hypernatremia, a decrease in cerebrospinal fluid pressure and possible intracranial hemorrhage. Do not administer more than 8 mEq/kg/day. A 4.2% solution is preferred for such slow administration. 

B. The sodium ion ioad and aikaiemia produced by hypertonic sodium bicarbonate reverse the sodium channel-dependent membrane-depressant ( quini-dine-like ) effects of several drugs (eg, tricyclic antidepressants, type la and type Ic antiarrhythmic agents, propranolol, propoxyphene, cocaine, and diphenhydramine). 

A. Several products are available, ranging from 4.2% (0.5 mEq/mL preferred for neonates and young children) to 7.5% (0.89 mEq/mL) to 8.4% (1 mEq/mL) in volumes of 10-500 mL. The most commonly used formulation available in most emergency crash carts is 8.4% ( hypertonic ) sodium bicarbonate, 1 mEq/mL, in 50-mL ampules or prefilled syringes. 

Example, sodium-rich medications, sodium bicarbonate, hypertonic IV fluids, nutrition, enemas, dialysis, plasma products (sodium citrate content)... 

Extravasation Extravasation of IV hypertonic solutions of sodium bicarbonate may cause chemical cellulitis (because of their alkalinity), with tissue necrosis, ulceration, or sloughing at the site of infiltration. Prompt elevation of the part, warmth, and local injection of lidocaine or hyaluronidase are recommended to prevent sloughing. 

McCabe JL, Cobaugh DJ, Menegazzi JJ, and Fata J (1998) Experimental tricyclic antidepressant toxicity A randomized, controlled comparison of hypertonic saline solution, sodium bicarbonate and hyperventilation. Annals of Emergency Medicine 32 329-333. 

The presence of excess TBW and hypernatremia indicates a net gain of water and Na, with Na gain in excess of water (see Figure 46-3). This condition is commonly observed in hospital patients receiving hypertonic saline or sodium bicarbonate. Other causes of hypervolemic hypernatremia include hyperaldosteronism and Cushing s syndrome (see Chapters 24 and 51). Excess aldosterone and cortisol (which also act as ligands for the distal tubule aldosterone receptor) results in excess Na and water retention. Corticosteroid therapy can have similar effects as weh. 

Administration of hypertonic saline can result in hypernatremia and an expanded ECF volume. This is typically iatrogenic, and may follow administration of sodium bicarbonate, use of hypertonic saline enemas, or intrauterine injection of hypertonic saline. Rarely, patients with hyperaldosteronism spontaneously present with an expanded ECF and mild hypernatremia. ... 

Excessive intake from ingestion of unintentional sodium sources or excess infusion of sodium (i.e., treatment of acidosis with excessive sodium bicarbonate or high-sodium hypertonic intravenous fluids). 

It is about an active mechanism depending on the Na+-K+-ATPase enzyme located in the lateral plasma membrane of the endothelial cells. It enables the penetration of potassium into the cell against the excretion of sodium into the aqueous humor. Then this latter becomes hypertonic in comparison with the stroma and thus drains the water. In normal conditions, the pump can adapt to the physiological needs. Actually, the moves of the sodium ion are relative to those of the bicarbonate ion (responsible for the negative polarization of the back side of the endothelial cell) and to the pH variation. And yet, the bicarbonate comes from the aqueous humor and from the intracellular transformation of carbon dioxide and water by carbonic anhydrase. All of this shows the good functioning of the pumps depends on the integrity of the plasma... 

Q6 Pilocarpine eyedrops are suitable. In severe conditions, in addition to the eyedrops, intravenous acetazolamide and intravenous hypertonic mannitol (an osmotic agent) may be used to reduce pressure. Acetazolamide prevents the actions of carbonic anhydrase in the ciliary body and inhibits bicarbonate synthesis. This causes reduction in sodium transport and aqueous humour formation since there is a link between bicarbonate and sodium transport. 

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