Pharm

Sodium Bicarbonate

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Sodium Bicarbonate, NaHCO3, Serum Alkalinization

  • See Also
  1. Bicarbonate Supplementation for Renal Tubular Acidosis
  2. Urine Alkalinization
  3. Sodium Bicarbonate in Severe Metabolic Acidosis
  • Precautions
  1. Sodium Bicarbonate is not a first line drug for Resuscitation
    1. Treat acidosis with ventilation and perfusion (bicarbonate may suppress respiratory drive)
    2. Bicarbonate has not been shown to improve survival
  2. Bicarbonate may transiently depress CV parameters (related to Electrolyte shifts, Hypocalcemia, Hypokalemia)
    1. Cardiac Function
    2. Coronary Artery perfusion
  • Indications
  1. Documented severe Metabolic Acidosis associated with:
    1. See Sodium Bicarbonate in Severe Metabolic Acidosis
    2. Prolonged Cardiac Arrest
    3. Unstable hemodynamic state
    4. Diabetic Ketoacidosis with Arterial pH <6.9
    5. Pulmonary Hypertension in the newborn
      1. Associated with Base Excess below -10
    6. Significant bicarbonate loss (e.g. Renal Tubular Acidosis, severe Diarrhea)
  2. Hyperkalemia
    1. See Acute Hyperkalemia Management
  3. Medication overdosage (alkalinize serum and urine)
    1. See Urine Alkalinization
    2. Salicylate Poisoning
    3. Tricyclic Antidepressant Poisoning
  • Preparations
  • Intravenous Concentrations
  1. Bicarbonate 4.2% (0.5 meq/ml in 10 ml ampule)
    1. Child under 3 months old
  2. Bicarbonate 8.4% (1 meq/ml in 50 ml prefilled syringe)
    1. Equivalents of Sodium Bicarbonate (NaHCO3)
      1. Standard bicarb ampule is 50 meq in 50 ml
      2. Equivalent to 8.4 grams/dl or 4.2 grams/50 ml
      3. One ampule = 50 meq = 4.2 grams = 50 mmoles
    2. Do not use 8.4% in child under 3 months old
      1. Bicarbonate 8.4% is hyperosmolar (2000 mosm/L)
      2. Intraventricular bleeding risk in Preterm Infant
    3. Use in Child over 3 months old and adults
  3. Preparation for infusion
    1. Sodium Bicarbonate 8.4%: 1 amp (50 meq or 50 mmol)
    2. Dilute NaHCO3 in 400 ml of D5W
    3. Do not administer at a rate >200 ml/hour
  • Dosing
  • Intravenous Emergency dosing
  1. Precaution
    1. Bicarbonate recommendations vary
    2. Use this as a general resource only
    3. Base actual dosing on standard Pharmacology texts
    4. IV infusion must be slow even in emergency
  2. Initial Dose: 1 meq/kg IV or IO over 1-2 minutes
  3. Additional Dose: 0.5 meq/kg IV or IO every 10 minutes
    1. Repeat for persistent severe Metabolic Acidosis
    2. Base repeat dosages on Arterial Blood Gas
  4. Continuous Infusion: 5% bicarbonate (297.5 meq/500ml)
  1. See Urine Alkalinization
  • Administration guidelines
  1. Do not give by endotracheal route
  2. Irrigate IV or IO tubing with Normal Saline
    1. Irrigate before and after bicarbonate infusion
  • Adverse reactions
  1. Overcompensation results in Metabolic Alkalosis
    1. Impaired tissue Oxygen Delivery
    2. Hypokalemia (intracellular shift)
    3. Hypocalcemia
    4. Lowered fibrillation threshold
    5. Sodium and water overload
  2. Inactivates Catecholamines
  3. Precipitates Calcium Salts
  4. Extravasation into subcutaneous tissue
    1. Scleroses small veins
    2. Local Chemical Burn
  5. Intracranial Hemorrhage in newborns (hyperosmolality)
    1. Use only 4.2% bicarbonate in under age 3 months
  • References
  1. Yavorsky and Glauser (2023) Crit Dec Emerg Med 37(9): 24-9