Sodium Bicarbonate || EMS Pharmacology

💊Sodium Bicarbonate💊

I’m always a fan of a medication that has multiple uses and in this regard, sodium bicarbonate does not disappoint. Sodium bicarbonate is an alkalinizing agent and antidote that has multiple indications in EMS. 

Let’s talk about them! 

Tricyclic antidepressant & aspirin overdoses - Sodium bicarbonate is used as an antidote and a way to restore pH levels. In the case of a severe TCA overdose, the administration of sodium bicarbonate & correction of electrolyte or pH abnormalities can actually improve cardiac function and dysrhythmias. 

Crush & compartment syndrome - When an area of the body is deprived or restricted of normal blood flow and oxygen, acid will build up. Once this acid is released in the bloodstream (after an object is removed or the patient with the injury is moved), it can have disastrous consequences for the patient. Sodium bicarbonate is indicated in these situations to neutralize the built up acid.

Hyperkalemia - I did not want to include this in the list because it is debatable in the 911 prehospital setting. 911 EMS providers do not typically have access to lab values. There is not a way we can put a value to what a patient’s potassium is, therefore EMS providers aren’t out there frivolously loading patients up with sodium bicarbonate to “fix” hyperkalemia. There is, however, an indicator of hyperkalemia on a 12 lead (which we 100% have access to in the prehospital setting). Look out for those tall, peaked T waves & follow your protocol on when to administer sodium bicarbonate.

And just to be clear, there are situations that cause hyperkalemia that we treat (like crush injuries, diabetic ketoacidosis, etc.), but hyperkalemia alone is more complex in the prehospital setting. When all else fails, CALL MEDICAL CONTROL!

Acidosis due to long down time - Although removed from ACLS, there are protocols that still recommend sodium bicarbonate during cardiac arrest when there is a suspicion of long down time. Why? When a person does not breathe and the heart is not beating to circulate oxygenated blood, acid builds up. The use & effectiveness of sodium bicarbonate in these cases is highly debated. 

Traumatic brain injuries or head trauma - Mixing sodium bicarbonate & normal saline to create a hypertonic solution for patients with a TBI has shown to decrease intracranial pressure. I have not personally seen or heard of this one in street EMS, but it is used in flight medicine in conjunction with or in lieu of mannitol. 

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