CodeBlue
Drug Reference

Antidotes

Sodium bicarbonate

Alkalinizing agent

TCA toxicityAdult1–2 mEq/kg IV bolus, repeat to narrow QRS; target pH 7.45–7.55Peds1–2 mEq/kg
Hyperkalemic arrestAdult50 mEq IV pushPeds-

Indications

  • TCA / sodium channel blocker toxicity
  • Hyperkalemia (with acidosis)
  • Severe metabolic acidosis

Contraindications & cautions

  • Metabolic or respiratory alkalosis
  • Hypocalcemia (worsens)

Key pearls

  • Not routine in cardiac arrest
  • Flush the line: precipitates with calcium; inactivates catecholamines
  • Causes hypokalemia and hypernatremia

Used in

Hyperkalemia Emergency TCA Overdose