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]:
    • 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)[2]

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[3][4]
  • 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

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)

Adverse Reactions

Serious

  • Extravasation- cellulitis, tissue necrosis, ulcer
  • Metabolic alkalosis
  • Hypernatremia [5]

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:

Mechanism of Action

Comments

  • Sodium acetate can be used as a substitute for sodium bicarbonate during times of critical shortages[6]
    • 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

See Also

References

  1. eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749
  2. Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.
  3. Dybvik T, Strand T, Steen PA. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 1995 Apr;29(2):89-95. doi: 10.1016/0300-9572(95)00850-s. PMID: 7659873.
  4. Vukmir RB, Katz L; Sodium Bicarbonate Study Group. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006 Mar;24(2):156-61. doi: 10.1016/j.ajem.2005.08.016. PMID: 16490643.
  5. Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, Hargarten KM, Thompson B. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992 Jan;10(1):4-7. doi: 10.1016/0735-6757(92)90115-e. PMID: 1736913.
  6. Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.