탄산수소나트륨

알칼리화제 / 전해질 보충제

**탄산수소나트륨**은 수의 응급 및 중환자 치료뿐만 아니라 특정 질환의 만성 관리에 널리 사용되는 전신 및 요 알칼리화제입니다. - **응급 산-염기 관리**: 주로 근본 원인을 신속하게 되돌릴 수 없고 혈액 pH가 위험한 수준으로 떨어졌을 때 심각한 대사성 산증을 교정하는 데 사용됩니다. - **전해질 위기**: 생명을 위협하는 **고칼륨혈증**(칼륨을 세포 내로 이동시킴) 및 **고칼슘혈증**의 보조 치료제로 사용됩니다. - **요 알칼리화**: 소변 pH를 높여 특정 요석(예: 요산염, 시스틴)을 관리하거나 예방하기 위해 경구 투여합니다. > **임상 팁**: 심폐소생술(CPR) 및 당뇨병성 케톤산증(DKA)에서 탄산수소나트륨의 일상적인 사용은 더 이상 권장되지 않습니다. DKA에서는 세포 내 저칼륨혈증을 악화시키고 역설적 중추신경계 산증을 유발할 수 있습니다. CPR 중에는 환자의 환기가 충분하지 않으면 고탄산혈증을 유발할 수 있습니다.

작용 기전: Sodium bicarbonate acts as an exogenous source of bicarbonate anion (**$HCO_3^-$**), which is the primary extracellular buffer in the body. - **Buffering Acidosis**: $HCO_3^-$ combines with free hydrogen ions ($H^+$) to form carbonic acid ($H_2CO_3$), which then dissociates into water ($H_2O$) and carbon dioxide ($CO_2$). - **Pathway**: **$HCO_3^-$ + $H^+$ → $H_2CO_3$ → $H_2O$ + $CO_2$** (The $CO_2$ must be exhaled via the lungs, highlighting the need for adequate ventilation). - **Hyperkalemia Management**: By increasing blood pH, it stimulates the $Na^+/H^+$ exchanger and subsequently the $Na^+/K^+$-ATPase pump, driving **potassium into cells** and rapidly lowering serum potassium levels. - **Urinary Alkalinization**: Bicarbonate is excreted in the urine, raising the pH. This increases the solubility of weak acids (like uric acid and cystine) and decreases the solubility of weak bases.

동물 종별 용량

Sheep

Acidosis (Ruminants) · 2-5 mEq/kg IV for a 4-8 hour period · IV · Once · Over 4-8 hours

Goats

Acidosis (Ruminants) · 2-5 mEq/kg IV for a 4-8 hour period · IV · Once · Over 4-8 hours

Cats

Severe metabolic acidosis · mEq of bicarbonate required = 0.5 x body weight in kg x (desired total CO2 mEq/L minus measured total CO2 mEq/L). Give 1/2 of the calculated dose slowly over 3-4 hours IV. · IV · Once · Over 3-4 hours · Recheck blood gases and assess clinical status. Avoid over-alkalinization.
Metabolic acidosis secondary to uremia · 0.3 x body weight (kilograms) x the base deficit. Administration of one third of this dose slowly IV and the rest placed in the intravenous fluids. OR 1-2 mEq/kg of bicarbonate can be given as a slow IV bolus if blood gas is not possible. · IV · Once · Over several hours · Avoid rapid IV boluses. Recheck blood gas after 2-4 hours.
Adjunctive therapy of diabetic ketoacidosis · Dose (in mEq) = body weight in kgs. x 0.4 x (12 - patient's bicarbonate) x 0.5. Give above dose over 6 hours in IV fluids. · IV · Once · Over 6 hours · Only if plasma bicarbonate is <=11 mEq/L. Recheck and repeat if still <=11 mEq/L. Use is controversial.
Adjunctive treatment of hypercalcemic crisis · mEq of bicarbonate required = 0.3 x body weight in kg x (desired plasma bicarbonate mEq/L - measured plasma bicarbonate mEq/L); or 1 mEq/kg IV every 10-15 minutes; maximum total dose: 4 mEq/L · IV · q10-15m · Until effect or max dose
Adjunctive therapy for hyperkalemic crises · 2-3 mEq/kg IV over 30 minutes (if decreased tissue perfusion/renal failure and no DKA) OR 1-2 mEq/kg IV slowly · IV · Once · Over 30 minutes or slowly · Must be used judiciously.

투여 경로

IVPOSC

금기

Metabolic or respiratory alkalosis
Excessive chloride loss secondary to vomiting or GI suction
Patients at risk for development of diuretic-induced hypochloremic alkalosis
Hypocalcemia (alkalosis may induce tetany)
Hypoventilating patients
Hypercapnoeic patients
Animals unable to effectively expel carbon dioxide

이상반응

Metabolic alkalosis
Hypokalemia
Hypocalcemia
'Overshoot' alkalosis
Hypernatremia
Volume overload
Congestive heart failure
Shifts in the oxygen dissociation curve (decreased tissue oxygenation)
Paradoxical CNS acidosis leading to respiratory arrest
Hypercapnia (if not well ventilated during CPR)
Predisposition to ventricular fibrillation
Hypernatraemia
Congestive heart failure (due to sodium load)
Decreased tissue oxygenation (shift in oxygen dissociation curve)
Paradoxical CNS acidosis
Respiratory arrest

약물 상호작용

Anticholinergic agents · Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Azole antifungals (ketoconazole, itraconazole) · Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Ciprofloxacin, Enrofloxacin · Solubility is decreased in an alkaline environment; monitor for signs of crystalluria
Corticosteroids · Patients receiving high dosages of sodium bicarbonate and ACTH or glucocorticoids may develop hypernatremia
Diuretics (e.g., thiazides, furosemide) · Concurrent use in patients receiving potassium-wasting diuretics may cause hypochloremic alkalosis
Ephedrine · When urine is alkalinized, excretion may be decreased
Histamine2 blocking agents (e.g., cimetidine, ranitidine) · Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Iron products · Concomitant oral sodium bicarbonate may reduce absorption; administer separately
Oral medications (general) · Can increase or reduce absorption rate/extent; avoid giving other drugs within 12 hours of oral sodium bicarbonate
Quinidine · When urine is alkalinized, excretion may be decreased
Salicylates · When urine is alkalinized, excretion of weakly acidic drugs may be increased

모니터링

Acid/base status (venous or arterial blood gases)
Serum electrolytes (especially potassium, calcium, and sodium)
Urine pH (if being used to alkalinize urine)
Blood gas analysis (pH, pCO2, HCO3-)
Serum electrolytes (Na+, K+, Ca2+)
Respiratory rate and effort
Clinical signs of fluid overload or congestive heart failure

과용량

Overdose or overly rapid administration can cause **severe alkalosis**, leading to irritability, muscle twitching, or **tetany** (due to a sudden drop in ionized calcium). - **Mild Overdose**: May only require discontinuing the bicarbonate therapy or using a rebreathing mask. - **Severe Alkalosis**: May require intravenous calcium therapy to treat tetany. - **Electrolyte Correction**: Sodium chloride or potassium chloride may be necessary if hypokalemia or hypochloremia is present. > Always thoroughly check dosages and frequently monitor electrolyte and acid/base status during administration.

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