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🌱 來自: metabolic-acidosis

Sodium bicarbonate

pH of <7.1 or severe acute kidney injury and a pH of ≤7.2.

maintain a target pH >7.2

Rapid infusions of sodium bicarbonate may 1: 增加呼吸酸、2: 增加 lactate 代謝、3: 降 iCa、4: 🧂sodium 太多

• increase the partial pressure of carbon dioxide (PCO2),
• the production of lactate,
• lower the ionized calcium,
• expand the extracellular space,
• and raise the serum sodium concentration.

Example regimens

Intermittent therapy: 7.5% or 8.4% sodium bicarbonate: IV:

• Initial: 89.2 to 100 mEq once over 1 to 2 minutes;
• reassess pH, serum bicarbonate level, and clinical status every 2 hours.
• If pH remains below target (~7.2 to 7.3), administer an additional 44.6 to 100 mEq sodium bicarbonate or initiate a continuous infusion (Ref).

Example: 100 mEq of 8.4% sodium bicarbonate once over 1 to 2 minutes, then repeat with 50 to 100 mEq or initiate a continuous infusion if pH remains below target (Ref).

• Continuous infusion: IV: Sodium bicarbonate estimated dose (mEq) = 0.5 × weight (kg) × [goal serum bicarbonate – observed serum bicarbonate (mEq/L)]; generally, goal serum bicarbonate is ~8 to 12 mEq/L (Ref). Note: In the equation above, “0.5 × weight (kg)” represents the estimated bicarbonate Vd.

Note: Administer the calculated amount of bicarbonate (mEq) over several hours (eg, 2 to 4 hours) until pH is ~7.2 to 7.3; reassess pH, serum bicarbonate level, and clinical status every 2 hours, and adjust dose as needed until goals are reached (Ref).

Example: For estimated bicarbonate deficit of 150 mEq, administer sodium bicarbonate [8.4%] 150 mEq in 1 L D5W over 2 to 4 hours, then reassess pH, serum bicarbonate level, and clinical status. Adjust dose if pH remains below target (Ref).