NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5313

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Policies: 01/10/98

1. Class:

1. Alkalizing agent, buffer.

2. Indications:

1. Prolonged cardiac arrest setting.
2. Known preexisting hyperkalemia.
3. Known or suspected diabetic ketoacidosis.
4. Tricyclic antidepressant overdose.
5. Phenobarbital overdose.
6. Consider use in traumatic crush type chest injuries.

3. Therapeutic Effects:

1. Acts as a buffer, but has several undesirable physiologic effects.
2. Can reduce hyperkalemia secondary to acid base shifts.

4. Contraindications:

1. Absolute:

1. Metabolic or respiratory alkalosis.
2. History prolonged vomiting.

1. Relative:

1. Congestive heart failure.

5. Adverse Effects:

1. Alkalosis.

6. Administration and Dosage:

1. Adult: 1 mEq/ kg IV, may repeat 0.5 mEq/ kg every 10 minutes.
2. Pediatric: 1 mEq/ kg, IV or IO, , may repeat 0.5 mEq/ kg, every 10 minutes.
3. Neonate: (< 5 kg): 4.2 % 1 meq/ kg, iv or io (Dilute 1 to 1 with IV solution) and give over 1 to 2 minutes.

7. Special Information:

1. Not recommended for routine use in cardiac arrest setting. Use only after intubation and adequate CPR with continuing arrest.
2. Use with caution in patients who cannot tolerate a salt load.
3. Can cause intracerebral hemorrhage especially in the pediatric patient.
4. Precipitates if mixed with other medications.