Norepinephrine and Sodium Bicarbonate Administration

Incompatibility and Administration

• Adrenergic drugs like norepinephrine are inactivated in alkaline solutions such as sodium bicarbonate, which can lead to decreased efficacy of norepinephrine 1
• When both medications are needed simultaneously, the American Heart Association recommends administering them through separate IV lines or using a multi-lumen catheter with separate ports 1

Clinical Scenarios and Medication Administration

• In cases of tricyclic antidepressant overdose, sodium bicarbonate is recommended for cardiotoxicity, while norepinephrine may be needed for persistent hypotension, according to the American Heart Association 2, 3, 4
• Norepinephrine is typically administered as a continuous infusion at 0.1-1.0 μg/kg/min, titrated to effect, and requires careful monitoring for extravasation, which can cause severe tissue injury, as recommended by the American Academy of Pediatrics 6

Medication Preparation and Monitoring

• Sodium bicarbonate can be diluted in D5W for continuous infusions, and is commonly used for metabolic acidosis, hyperkalemia, and sodium channel blocker toxicity, according to the American College of Medical Toxicology 1