Sodium bicarbonate

Administration

• Type: 8.4% is common cardiac formulation
  • 8.4% is 1 mEq/mL
• Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
• Routes of Administration: IV
• Common Trade Names: N/A
• Abbreviation: NaHOC3

Adult Dosing

Cardiac Arrest

50 mL (1 amp) IV push for severe acidemia and patient is adequately ventilated

• Frequency:
  • 1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
  • 0.5 mEq/kg/dose q10min
  • OR tailor to serial ABGs

Severe Metabolic Acidemia (pH<7.1)

• IV drip
  • 150 mEq/1000 mL inD5W
  • May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis (although this study used 4.2% sodium bicarbonate, a product not widely available within the United States)

Serum alkalinization (toxicology)

• Enhance urinary elimination of salicylates, methotrexate and phenobarbital
• Goal: serum pH of 7.5, urinary pH of 8.0
• Check K+ as well
• IV drip
  • 150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour

Pediatric Dosing

Cardiac Arrest

• 1 mL/kg IV push for severe acidemia and patient is adequately ventilated
• Sodium bicarbonate administration in cardiac arrest has not been shown to improve survival to discharge
• ACLS guidelines recommend against routine use of sodium bicarbonate in cardiac arrest although there may be benefit in the setting of cardiac arrest caused by hyperkalemia or tricyclic antidepressant overdose

Special Populations

• Pregnancy Rating: C
• Lactation risk: Infant risk minimal

Renal Dosing

• Adult:
• Pediatric:

Hepatic Dosing

• Adult:
• Pediatric:

Contraindications

• Allergy to class/drug
• Relative:
  • Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia)
  • DKA with pH > 7.1

Adverse Reactions

Serious

• Extravasation: cellulitis, tissue necrosis, ulcer
• Metabolic alkalosis
• Hypernatremia

Pharmacology

• Onset: 15 minutes (IV)
• Duration: 1-2 hours (IV)
• Half-life:
• Metabolism:
• Excretion:

Mechanism of Action

• Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH

Comments

• Sodium acetate can be used as a substitute for sodium bicarbonate during times of critical shortages
  • Can be used to treat TCA and ASA toxicity
  • Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Aluminum phosphide poisoning	1-2mEq/kg IV bolus, then infusion to maintain pH >7.2	Correct metabolic acidosis	IV	Adult
Diabetic ketoacidosis	100 mEq in 400 mL sterile water IV over 2 hours	Severe acidosis (pH <6.9)	IV drip	Adult
Diabetic ketoacidosis (peds)	0.5-2 mEq/kg over 1-2 hr	Only if pH <7.0 and hemodynamic compromise	IV	Pediatric
Ethylene glycol toxicity	1-2 mEq/kg IV bolus	Correction of metabolic acidosis	IV	Adult
Local anesthetic systemic toxicity	1 amp (50 mEq) IV q2min for VTach/VF or severe acidosis	Alkalinization for cardiotoxicity	IV push	Adult
Methanol toxicity	1-2 mEq/kg IV bolus	Correction of metabolic acidosis	IV	Adult
Newborn resuscitation	1-2mEq/kg of 4.2% solution IV	Metabolic acidosis, use cautiously	IV	Pediatric