Sodium bicarbonate injection is available from various manufacturers in vials and syringes as an aqueous solution in concentrations of 4.2, 7.5, and 8.4%.3223; 3224 Carbon dioxide may have been added to some products to adjust the pH.3224
| Concentration | Bicarbonate (and Sodium) Concentration | Total Container Content | Osmolarity |
|---|---|---|---|
| 8.4% | 1 mEq/mL | 10 mEq/10 mL | 2000 mOsm/L |
| 8.4% | 1 mEq/mL | 50 mEq/50 mL | 2000 mOsm/L |
| 7.5% | 0.892 mEq/mL | 44.6 mEq/50 mL | 1790 mOsm/L |
| 4.2% | 0.5 mEq/mL | 5 mEq/10 mL | 1000 mOsm/L |
Sodium bicarbonate 4% neutralizing additive solution (Neut, Hospira) is available in 5-mL single-dose vials.3225 Each mL of solution provides 0.48 mEq of bicarbonate and sodium and 2 mg of edetate disodium anhydrous.3225 Sodium bicarbonate neutralizing additive solution is used to raise the pH of acidic solutions.3225
Equivalency
Each 84 mg of sodium bicarbonate provides 1 mEq of sodium and bicarbonate ions.3223; 3224
pH
Sodium bicarbonate is administered intravenously, either undiluted or diluted in other fluids.3223; 3224; 3225 It also has been administered subcutaneously if diluted to isotonicity (1.5%).2043
Sodium bicarbonate injection should be stored at controlled room temperature.3223; 3224; 3225 A solution that is unclear or that contains a precipitate should not be used.3223; 3224
Sodium bicarbonate injection under simulated summer conditions in paramedic vehicles was exposed to temperatures ranging from 26 to 38°C over 4 weeks. Analysis found no loss of the drug under these conditions.2562
Combining sodium bicarbonate with acids in aqueous solutions results in the liberation of carbon dioxide gas.2248 The bubbles can evolve to a sufficient quantity to cause effervescence.2248
The stability of sodium bicarbonate 7.5% in polypropylene syringes is inversely related to the storage temperature.136 Estimates of room temperature stability range from 1 week137 to 1 month.136 Refrigeration may increase the stability to 60137 to 90 days.136 Stability also may be increased by refrigerating the sodium bicarbonate injection and the syringes before preparation, rinsing the syringes twice with refrigerated sterile water for injection, minimizing the contact of the solution with the air by expelling the air from the syringes, and taping the plunger in place to minimize its movement from escaping carbon dioxide.137
pH Effects
Drugs such as sodium bicarbonate that may raise the pH of an admixture above 6 may cause significant decomposition of alkali-labile drugs.59; 77; 79
The change in pH that occurs when 5 mL of sodium bicarbonate 4% additive solution (Neut, Abbott) is added to a liter of 5 common infusion solutions (Travenol) was reported:1129
| Solution | Initial pH | pH after Neut Added | pH Increase |
|---|---|---|---|
| Dextrose 5% | 4.4 | 7.5 | 3.1 |
| Dextrose 10% | 3.9 | 7.1 | 3.2 |
| Ringer’s injection | 5.6 | 7.5 | 1.9 |
| Sodium chloride 0.45% | 5.6 | 7.8 | 2.2 |
| Sodium chloride 0.9% | 5.5 | 7.6 | 2.2 |
Standardize 4 Safety
One or more standardized concentrations for this drug have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care. (See Standardize 4 Safety in Users Guide.) Recommendations developed to date through this initiative are available at www.ashp.org/pharmacy-practice/standardize-4-safety-initiative.
Table 1. Standardize 4 Safety Continuous IV Infusion Standard Concentrations for Sodium Bicarbonate3635
| Patient Population | Concentration Standards | Dosing Units |
|---|---|---|
| Pediatric patients (50 kg) | 0.5 mEq/mL 1 mEq/mL | mEq/kg/hour |
Drugs in Syringe Compatibility
Y-Site Injection Compatibility (1:1 Mixture)
Additional Compatibility Information
Methylprednisolone
The compatibility of methylprednisolone sodium succinate (Upjohn) with sodium bicarbonate added to an auxiliary medication infusion unit has been studied. Primary admixtures were prepared by adding sodium bicarbonate 44.6 mEq/L to dextrose 5%, dextrose 5% in sodium chloride 0.9%, and Ringer’s injection, lactated. Up to 100 mL of the primary admixture was added along with methylprednisolone sodium succinate (Upjohn) to the auxiliary medication infusion unit with the following results:329
| Methylprednisolone Sodium Succinate | Sodium Bicarbonate 44.6 mEq/L Primary Solution | Results |
|---|---|---|
| 500 mg | D5S, D5W qs 100 mL | Clear solution for 24 hr |
| 500 mg | LR qs 100 mL or added to 100 mL LR | Clear solution for 1 hr |
| 1000 mg | D5W qs 100 mL | Clear solution for 24 hr |
| 1000 mg | D5S qs 100 mL or added to 100 mL D5S | Clear solution for 24 hr |
| 1000 mg | LR qs 100 mL | Clear solution for 1 hr |
| 1000 mg | Added to 100 mL LR | Clear solution for 4 hr |
| 2000 mg | D5S, D5W qs 100 mL | Clear solution for 24 hr |
| 2000 mg | LR qs 100 mL | Clear solution for 30 min |
| 2000 mg | Added to 100 mL LR | Clear solution for 4 hr |
For a list of references cited in the text of this monograph, search the monograph titled References.