Adult Dosing

Metabolic acidosis associated with cardiac arrest

• Start with 44.6-100 mEq rapid IV dose, continue with 44.6-50 mEq q5-10 minutes PRN

Non-life-threatening metabolic acidosis

• 2-5 mEq/kg IV over a period of 4-8 hrs; if severe symptoms have abated, reduce the frequency of administration and the size of the dose

Alkalinization of the urine

• 2-5 mEq/kg IV over a period of 4-8 hrs

Note:

• Avoid full correction of a low total CO₂ content during first 24 hrs of therapy due to the risk of unrecognized alkalosis
• In case of non-life-threatening metabolic acidosis, sodium bicarbonate may be added to other IV fluids

Methanol Poisoning [Non-FDA Approved]

• 0.25-1 mEq/kg IV slow, may be repeated as needed based upon venous or arterial pH and patient response

Pediatric Dosing

Metabolic acidosis due to cardiac arrest

• <2 yrs
• Up to 8 mEq/kg/day IV of 4.2% solution; alt: 0.3 x weight (in kg) x base deficit (mEq/L)

• >2 yrs
• Start with 44.6-100 mEq rapid IV dose, continue with 44.6-50 mEq q5-10 minutes PRN

Non-life-threatening metabolic acidosis

• <2 yrs
• Up to 8 mEq/kg/day IV of 4.2% solution

• >2 yrs
• 2-5 mEq/kg IV over a period of 4-8 hrs; if severe symptoms have abated, reduce the frequency of administration and the size of the dose

Alkalinization of the urine

• >2 yrs
• 2-5 mEq/kg IV over 4-8 hrs

Note:

• Avoid full correction of a low total CO₂ content during first 24 hrs of therapy due to the risk of unrecognized alkalosis
• In case of non-life-threatening metabolic acidosis, sodium bicarbonate may be added to other IV fluids

Methanol Poisoning [Non-FDA Approved]

• 0.25-1 mEq/kg IV slow, may be repeated as needed based upon venous or arterial pH and patient response

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of metabolic acidosis associated with
• Severe renal disease
• Uncontrolled diabetes
• Circulatory insufficiency due to shock or severe dehydration
• Extracorporeal circulation of blood
• Cardiac arrest
• Severe primary lactic acidosis

• Treatment of certain drug intoxications including barbiturates, poisoning by salicylates or methyl alcohol
• Alkalinization of the urine in hemolytic reactions
• Severe diarrhea accompanied by a significant loss of bicarbonate

• Hypersensitivity to any of the ingredients of the product
• Hypochloremia due to continuous vomiting or GI suction
• Concurrent use of diuretics that may induce hypochloremic alkalosis
• Excessive calcium intake

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined; use with caution

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Use cautiously in patients with CHF, severe renal impairment and conditions involving edema with sodium retention, as it may cause sodium retention, overhydration, dilution of serum electrolytes, fluid overload, congestion and pulmonary edema
• Use cautiously in patients with oliguria or anuria
• Exercise caution to avoid extravascular infiltration
• Ensure that the solution is clear and the container/seal is intact before use
• Administer parenteral solutions containing sodium ions cautiously in patients receiving corticosteroids or corticotropin during therapy
• Therapy may cause potassium depletion, predisposing patients to metabolic alkalosis. Co-existing hypocalcemia may cause carpopedal spasm due to increase in plasma pH. Appropriate correction of electrolyte imbalances before or during bicarbonate infusion can minimize such risks
• Rapid injection of hypertonic sodium bicarbonate solutions in neonates and children <2 yrs of age may produce hypernatremia, reduction in CSF pressure and possible intracranial hemorrhage. Slow administration rates and the 4.2% solution are recommended in neonates. The risk of rapid infusion must be weighed against the potential for fatality due to acidosis in emergencies such as cardiac arrest
• Avoid adding sodium bicarbonate to parenteral solutions containing calcium, except where compatibility has been previously established
• Periodic monitoring of CO₂ content and blood pH is recommended to prevent risk of overdosage
• The risks of overdosage and alkalosis should be avoided by giving repeated small doses and monitoring appropriate laboratory tests

Cautions: Use cautiously in

• Hypocalcemia
• Hypokalemia
• Hypervolemia
• Bartter syndrome
• Hypernatremia
• Children <2 yrs

Pregnancy Category:C

Breastfeeding: Safety unknown.

• CV: CHF exacerbation
• CNS: Seizures
• PSYCHIATRY: Irritability
• METABOLIC: Metabolic alkalosis, hypernatremia
• LOCAL: Ulceration, sloughing, tissue necrosis, injection site pain
• MUSC: Muscular twitchings, tetany
• MISC: Extravasation cellulitis, edema

• Alkalinizing agent; increases plasma bicarbonate, buffers excess hydrogen ion concentration, and raises blood pH, thereby reversing the clinical manifestations of acidosis; also increases the excretion of free bicarbonate ions in the urine, causing alkalinization of urine
• Metabolism: Unknown
• Excreted in urine
• Half-life: Unknown

US Trade Name(s)

• Only generic available

US Availability

sodium bicarbonate (generic)

• INJ (prefilled syringes): 0.9 mEq/mL (50 mL prefilled syringe)
• INJ (prefilled syringes): 1 mEq/mL (50 mL prefilled syringe)

Canadian Trade Name(s)

• Only generic available

Canadian Availability

sodium bicarbonate (generic)

• INJ: 42 mg/mL
• INJ: 75 mg/mL
• INJ: 84 mg/mL

UK Trade Name(s)

• Only generic available

UK Availability

sodium bicarbonate (generic)

• INJ: 4.2% w/v (10 mL vial)
• INJ: 8.4% w/v (10, 50 mL vial)

Australian Trade Name(s)

• Only generic available

Australian Availability

sodium bicarbonate (generic)

• INJ (prefilled syringes): 84 mg/mL (50 mL prefilled syringe)
• INJ: 84 mg/mL (10 mL vial)

[Outline]

Emergency/Critical Care

Other Antidotes

Nutrition/Electrolytes

Acid-Base