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BLOOD AND BLOOD FORMING ORGANS › BLOOD SUBSTITUTES AND PERFUSION SOLUTIONS › IRRIGATING SOLUTIONS › Salt solutions
sodium bicarbonate
B05CB04
Forms & Strengths
- Injectable solution: 4.2% (0.5 mEq/mL)
- Injectable solution: 8.4% (1 mEq/mL)
- Oral tablets: 325 mg (3.8 mEq)
- Oral tablets: 650 mg (7.6 mEq)
Adult Dosing
- Metabolic acidosis: 2 to 5 mEq/kg IV infused over 4 to 8 hours based on blood gas determinations
- Cardiac arrest: 1 mEq/kg IV push once, repeat 0.5 mEq/kg every 10 minutes as indicated by arterial pH
- Urinary alkalinization: 325 mg to 2 g (approx. 4 to 24 mEq) oral 1 to 4 times daily
- Indigestion: 325 mg to 2 g oral PRN
Pediatric Dosing
- Metabolic acidosis (neonates/infants): 1 mEq/kg/dose slow IV infusion (4.2% solution only) or dilute 8.4% with D5W
- Metabolic acidosis (children): 2 to 5 mEq/kg IV infused over 4 to 8 hours
- Cardiac arrest (neonates/pediatrics): 1 mEq/kg/dose IV/IO slow push (maximum 50 mEq/dose at a rate not exceeding 10 mEq/min)
Indications
- Treatment of severe metabolic acidosis
- Alkalinization of urine in poisoning (e.g., barbiturates, salicylates, methanol)
- Adjunct in severe hyperkalemia
- Emergency treatment of cardiac arrest unresponsive to other measures
- Treatment of hyperacidity / dyspepsia
Mechanism of Action
- Dissociates to provide bicarbonate ion (HCO3-)
- Neutralizes excess hydrogen ion (H+) concentration
- Raises blood and urinary pH by buffering metabolic acids
- Shifts extracellular potassium intracellularly in hyperkalemia
Contraindications
- Metabolic or respiratory alkalosis
- Hypocalcemia where alkalosis may induce tetany
- Hypertension, edema, or congestive heart failure where sodium load is hazardous
- Patients losing chloride from continuous vomiting or continuous gastrointestinal suction
- Risk of urinary calculi
Adverse Reactions
- Metabolic alkalosis from over-correction
- Hypernatremia and hyperosmolality
- Hypokalemia and hypocalcemia
- Tissue necrosis and sloughing upon extravasation
- Fluid overload, pulmonary edema, and exacerbation of heart failure
- Paradoxical central nervous system acidosis (with rapid IV administration)
Drug Interactions
- Alters urinary excretion of acidic and basic drugs by changing urinary pH (e.g., increases excretion of salicylates and barbiturates)
- Decreases absorption of acidic medications (e.g., ketoconazole, iron)
- May precipitate calcium when administered concurrently in the same IV line
- Increases risk of cardiac arrhythmias when combined with digitalis glycosides in hypokalemia
Curated Content: Needs Vetting Before Put to Clinical Use