Intravenous sodium bicarbonate

Intravenous sodium bicarbonate, also known as sodium hydrogen carbonate, is a medication primarily used to treat severe metabolic acidosis. For this purpose it is generally only used when the pH is less than 7.1 and when the underlying cause is either diarrhea, vomiting, or the kidneys. Other uses include high blood potassium, tricyclic antidepressant overdose, and cocaine toxicity as well as a number of other poisonings. It is given by injection into a vein. Intravenous sodium bicarbonate, also known as sodium hydrogen carbonate, is a medication primarily used to treat severe metabolic acidosis. For this purpose it is generally only used when the pH is less than 7.1 and when the underlying cause is either diarrhea, vomiting, or the kidneys. Other uses include high blood potassium, tricyclic antidepressant overdose, and cocaine toxicity as well as a number of other poisonings. It is given by injection into a vein. Side effects may include low blood potassium, high blood sodium, and swelling. It is not recommended in people with low blood calcium. Sodium bicarbonate is in the alkalinizing family of medication. It works by increasing blood bicarbonate, which buffers excess hydrogen ion and raises blood pH. Commercial production of sodium bicarbonate began between 1791 and 1823. Intravenous medical use began around the 1950s. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. Sodium bicarbonate is available as a generic medication. The wholesale cost in the developing world is about US$0.09–2.58 per 10 ml of 8.4% solution. In the United Kingdom this amount costs the NHS about 11.10 pounds. Intravenous sodium bicarbonate is indicated in the treatment of metabolic acidosis, such as can occur in severe kidney disease, diabetic ketoacidosis, circulatory insufficiency, extracorporeal circulation of blood, in hemolysis requiring alkalinization of the urine to avoid nephrotoxicity of blood pigments, and certain drug intoxications, such as by barbiturate overdose, salicylate poisoning, tricyclic antidepressant overdose or methanol poisoning. In addition, sodium bicarbonate is indicated in severe diarrhea, where large amounts of bicarbonate may be lost. However, overall treatment should also strive to treat the underlying cause of the acidosis, such as giving insulin in case of diabetic ketoacidosis. Dhaka fluid is one of the IV fluids used in intravenous rehydration therapy which has sodium bicarbonate content in it. Used as a resuscitative fluid in burn management. Intravenous sodium bicarbonate is contraindicated in patients who are losing chloride, such as by vomiting. Because of its sodium content, intravenous sodium bicarbonate should be used with great care, if at all, in patients with congestive heart failure and severe chronic kidney disease, where low sodium intake is strongly indicated to prevent sodium retention. By similar rationale, intravenous sodium bicarbonate should be given with caution to patients receiving corticosteroids. Extravasation of intravenous sodium bicarbonate has been reported to cause chemical cellulitis because of its alkalinity, resulting in tissue necrosis, ulceration and/or sloughing at the site of infiltration. This condition is managed by prompt elevation of the part, warmth and local injection of lidocaine or hyaluronidase. Norepinephrine and dobutamine cannot be used as additives in an intravenous sodium bicarbonate solution.