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

 
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 [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

 
mL/kg IV push for severe acidemia and patient is adequately ventilated

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

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[3]
    • 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. 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.
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