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	You are here: Home > Managing Internal Contamination > Sodium Bicarbonate		Help on REMM New Users: Where Do I Start? What's New on REMM? (12/2012) Multimedia Library Tools Download REMM (12/2012) Download Mobile REMM (12/2012) Dictionary Emergency Contacts Dose Estimator for Exposure Scarce Resources Triage Tool Manage ARS Subsyndromes Print Algorithms & Tables Diagnosis & Treatment Patient Management Algorithms Acute Radiation Syndrome (ARS) Hematopoietic Subsyndrome Cutaneous Radiation Syndrome Time/Dose Effects in ARS Time Phases of ARS Isotopes of Interest Countermeasures: Internal Contamination Countermeasures: Exposure Decontamination Procedures Strategic National Stockpile    Population Monitoring and Radionuclide Decorporation Following a Radiological or Nuclear Incident (NCRP Report No. 166, 2011) Nuclear Detonation Scarce Resources Working Group Publications, 3/2011 (HHS/ASPR) Response to a Nuclear Detonation: State and Local Medical Planners Playbook, 3/2011 (HHS/ASPR) Responding to a Radiological or Nuclear Terrorism Incident: A Guide for Decision Makers (NCRP Report No. 165, 2010) Management of Persons Contaminated With Radionuclides: Handbook (NCRP Report No. 161, Vol. I, 2008) Planning Guidance for Response to a Nuclear Detonation, 2nd Ed, 6/2010 (National Security Staff)    AFRRI AHRQ CDC CRCPD DHS DOE EPA FDA HHS HPS IAEA   ICRP NACCHO NARR NCRP NRC OSHA REAC/TS RERF RITN UNSCEAR WHO
	Sodium Bicarbonate (NaHCO3) Indications and Usage Reference Links Indications and Usage Used to alkalinize the urine after uranium intake, which protects the kidneys from uranium deposition. Suggested IV dosing 2 ampoules (44.3 mEq bicarbonate/ampoule) in 1000 cc 5% dextrose in water (D5W) or 0.9% sodium chloride (normal saline, NS) or 250 cc (1-2 mEq/kg) via slow IV infusion Administer therapy until urine pH is 8-9; monitor urine pH hourly Continue Rx for 3 days Suggested PO dosing 2 bicarbonate tablets PO q 4 hr Administer therapy until urine pH is 8-9; monitor urine pH hourly Continue Rx for 3 days For suspected high level uranium intake, consider off-label use of PO diuretics and/or dialysis Etidronate (Didronel) 400 mg PO QD or Diamox 500 mg PO BID. Continue Rx for 3 days. Therapy efficacy and safety can be monitored and guided by Collecting 24-hour urine and fecal specimens and analyzing for uranium content as well as for chemical toxicity (e.g., proteins, microglobulin, casts) Monitoring serum renal function tests FDA Product Safety Info Not FDA approved for this indication/off-label use WARNING: Pregnancy Category C top of page Reference Links There is minimal actual clinical experience in the treatment of uranium-exposed patients with NaHCO3, but NCRP and some medical experts consider it safe and reasonable1. top of page References Management of Persons Contaminated with Radionuclides: Handbook (NCRP Report No. 161, Vol. I), National Council on Radiation Protection and Measurements, Bethesda, MD, 2008, Medical Treatments Arranged by Radionuclide (pp. 228-233). [Note: NCRP 161 supersedes NCRP 65.]

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