...SODIBICARB for correcting metabolic acidosis = 20% of body weight x Base Excess in minus (BE: normal -2 to +2 mmol/L) = 0.2 x Wt x base excess!
P.S. MILLIEQUIVALENT (mEq) of sodibicarbonate = NaHCO3 23+1+12+16+16+16= 84 mg. Therefore, one mEq of Sodibicarb weighs 84 mg.
The Sodibicarb ampoules are 8.4% implying 8.4 gm% = 8.4 gm solute in 100 ml of the solvent = 8400 mg in 100 ml = 84 mg per ml = 84 mg/ml i.e. one mEq/ml.
Therefore, to correct an acidosis: BE -12 and body weight 50 kg = 0.2x50x12=120 mEq i.e. 120 ml of 8.4% Sodibicarb can be given slowly over at least 2-4 hours in Dextrose Normal Saline or Normal Saline or 5% Dextrose 500 ml!
...better to correct half of the calculated dose: initially 60 ml of the Sodibicarb can be given over 2-4 hours because the body's buffers as well mop up the hydrogen ions! Too rapidly or excess of Sodibicarb given can cause intracellular acidosis by releasing CO2, which is 20 times more soluble than O2 and diffuses into cells and combine with water to form Carbonic Acid! The induced intracellular acidosis will not allow the mitochondrial enzymes to function and cause less energy production and slow intracellular biochemical processes resulting into ischaemia and oedema further worsening the brain and other organ function, though the repeat ABG will show corrected pH. It is important to treat the patient and not the numbers!
...Respiratory acidosis must be corrected by appropriate ventilation rather than by Sodibicarb because with the increase in CO2, there is increase in HCO3, both being in the same equation: CO2 + H2O = H2CO3 = H+. + HCO3. Therefore, when CO2 rises, HCO3 also rises. Then, why to give Sodibicarb, when HCO3 is higher than normal (22-26 mmol/L)?
...when the HCO3 is lower than normal (24 mmol/L) of the patient 19 mmol/L and the BE is not calculated by the ABG machine, then the formula is: 50% of body weight x HCO3 deficit = 0.5 x 50 x (24-19)= 0.5x50x5=125 mEq or mmol because one mol is equal to one mEq of Sodibicarb!
...through oral or nasogastric route in moderate metabolic acidosis Sodibicarb can be given up to 2 gm once to four times a day. One gram of Sodibicarb = 1000 mg divided by 84 mg (each mEq) = 11.9 mEq of Sodibicarb or 11.9 ml of 8.4% Sodibicarb!
Usual Adult Dose for Metabolic Acidosis
https://www.drugs.com/dosage/sodium-bicarbonate.html
Sodium Bicarbonate Dosage:
https://www.drugs.com/dosage/sodium-bicarbonate.html
SODIUM BICARBONATE DEFICIT CALCULATOR:
http://globalrph.com/medcalcs/sodium-bicarbonate-deficit-calculator/
P.S. MILLIEQUIVALENT (mEq) of sodibicarbonate = NaHCO3 23+1+12+16+16+16= 84 mg. Therefore, one mEq of Sodibicarb weighs 84 mg.
The Sodibicarb ampoules are 8.4% implying 8.4 gm% = 8.4 gm solute in 100 ml of the solvent = 8400 mg in 100 ml = 84 mg per ml = 84 mg/ml i.e. one mEq/ml.
Therefore, to correct an acidosis: BE -12 and body weight 50 kg = 0.2x50x12=120 mEq i.e. 120 ml of 8.4% Sodibicarb can be given slowly over at least 2-4 hours in Dextrose Normal Saline or Normal Saline or 5% Dextrose 500 ml!
...better to correct half of the calculated dose: initially 60 ml of the Sodibicarb can be given over 2-4 hours because the body's buffers as well mop up the hydrogen ions! Too rapidly or excess of Sodibicarb given can cause intracellular acidosis by releasing CO2, which is 20 times more soluble than O2 and diffuses into cells and combine with water to form Carbonic Acid! The induced intracellular acidosis will not allow the mitochondrial enzymes to function and cause less energy production and slow intracellular biochemical processes resulting into ischaemia and oedema further worsening the brain and other organ function, though the repeat ABG will show corrected pH. It is important to treat the patient and not the numbers!
...Respiratory acidosis must be corrected by appropriate ventilation rather than by Sodibicarb because with the increase in CO2, there is increase in HCO3, both being in the same equation: CO2 + H2O = H2CO3 = H+. + HCO3. Therefore, when CO2 rises, HCO3 also rises. Then, why to give Sodibicarb, when HCO3 is higher than normal (22-26 mmol/L)?
...when the HCO3 is lower than normal (24 mmol/L) of the patient 19 mmol/L and the BE is not calculated by the ABG machine, then the formula is: 50% of body weight x HCO3 deficit = 0.5 x 50 x (24-19)= 0.5x50x5=125 mEq or mmol because one mol is equal to one mEq of Sodibicarb!
...through oral or nasogastric route in moderate metabolic acidosis Sodibicarb can be given up to 2 gm once to four times a day. One gram of Sodibicarb = 1000 mg divided by 84 mg (each mEq) = 11.9 mEq of Sodibicarb or 11.9 ml of 8.4% Sodibicarb!
Usual Adult Dose for Metabolic Acidosis
https://www.drugs.com/dosage/sodium-bicarbonate.html
Sodium Bicarbonate Dosage:
https://www.drugs.com/dosage/sodium-bicarbonate.html
SODIUM BICARBONATE DEFICIT CALCULATOR:
http://globalrph.com/medcalcs/sodium-bicarbonate-deficit-calculator/
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