sodium bicarbonate infusion in NS

[rxjc]

Can you administer sodium bicarbonate in ns? package insert states its compatible. The osmolarity of sodium bicarbonate in NS 1 L is about 529...but i always see it in D5 or D5-1/2NS? Anyone know the reason? is it sodium overload??

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[radio frequency]

Can you administer sodium bicarbonate in ns? package insert states its compatible. The osmolarity of sodium bicarbonate in NS 1 L is about 529...but i always see it in D5 or D5-1/2NS? Anyone know the reason? is it sodium overload??

To my knowledge, this is the reason.

 

[njac]

It's more the tonicity than the "sodium overload" although that might be what you were getting at.

 

[all4rx]

that's like a semi-hypertonic fluid, about ~ half of 3% NS, I think. I always call physicians up to alert them and have them changed the orders. Some argues back that the D5W may provide too much "sugar" for their diabetic pts...here comes another argument of how D5 is not a good source of carb providing fluid....

 

[MackandBlues]

No you cannot mix sodium bicarb with NS because it's too much sodium unless they want the patient to be hypertonic. Reasoning = most drips call for 3 amps of sodium bicarb which is a total of 150 meq of sodium. Add that to the sodium in 1 liter of NS which is 154 meq you have 304 meq of sodium in your 1 liter drip. way too much for most patients. Mix 150 meq sodium bicarb in D5w or sterile water. Or do 75 meq of sodium bicarb in 1 liter of 1/2 NS.

 

[confettiflyer]

I always thought the free water in D5 was more of an issue than any supposed carb load for a hyperglycemia pt.

 

[njac]

An entire liter of D5w has the same amount of dextrose as a 50mL amp of D50.

Watch me get excited about that carb load, especially over several hours. Not.

 

[Praziquantel86]

Our main users seemed to the neuro ICU, for patients who had a simultaneous need for hypertonic saline and were acidotic.

 

[Bostonredsox]

Do not give NS with bicarb. ODS is no bueno for happy neurons. You are essentially giving hot salt. D5 with 3 amps or 1/2NS with 2 amps if there CVP is in the toilet and you need volume in addition to correction of acidosis (the later is around 177 Meq, not a ton more than isotonic NS)
If one of my interns running around the MICU writes for bicarb in NS and I catch them before one of the clnical pharmacists does they know they are toast.

 

[Bostonredsox]

Our main users seemed to the neuro ICU, for patients who had a simultaneous need for hypertonic saline and were acidotic.

while this seems ok physiologically, it is rarely the case. The neuro ICU pts who need hot salt generally are getting infusions of around 30-40 ml/hr. That is such a small infusion rate of a bicarb drip it will not have a major effect on correcting an acidosis in any reasonable amount of time.

 

[Praziquantel86]

while this seems ok physiologically, it is rarely the case. The neuro ICU pts who need hot salt generally are getting infusions of around 30-40 ml/hr. That is such a small infusion rate of a bicarb drip it will not have a major effect on correcting an acidosis in any reasonable amount of time.

Be that as it may, they still utilized it. Whether it was beneficial is another story.

 

[Bostonredsox]

Be that as it may, they still utilized it. Whether it was beneficial is another story.

Not disagre'n with you, i have seen it quite a bit. But then again, I see things all the time that lack evidence that they show any benefit, or atleast not cause harm...