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Sodium bicarbonate iv injection
- 台灣的 7% NaHCO3 : 16.7 mEq/20 mL/amp
- 美國的 8.4% NaHCO3 : 50 mEq/50 mL/amp
- 台灣目前 Rolikan 是 7% 20 mL/amp
(美國的 1 amp = 台灣的 3 amp)
NaHCO3 的劑量一般是
1 mEq/kg ST followed by 0.5 mEq/kg as needed
要給 50 mEq 的 NaHCO3, 在美國是給 1 amp (8.4% 50 cc/amp)
台灣是給 3 amp (7% 20cc/amp)
Buffer therapy
For sodium bicarbonate loss due to diarrhea or proximal RTA is useful.
May have negative effects : Generation of significant quantities of CO2
-> Paradoxical worsening of intracellular acidosis 惡化細胞內酸
-> Worsening respiratory acidosis 惡化呼吸酸
Bicarbonate therapy should not be used in the ED for mild to moderate metabolic acidosis.
Goal of bicarbonate and dialysis therapy in lactic acidosis is to bridge
the patient to definitive treatment of the etiology.
Bicarbonate therapy may be appropriate for limited indications.
The goal is to restore adequate buffer capacity ([HCO3] > 8 mEq/L) or
to achieve clinical improvement in shock or dysrhythmias.
- HCO3 < 8
- Severe acidosis (pH < 7.15)
Initial 1mEq/kg, then 0.5mEq/kg Q10 min if need
Textbook : 75mEq in D5W 500ml for isotonic
Dosed 0.5 mEq/kg for each mEq/lto rise in HCO3
8 – (HCO3) * 0.5 * BW
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