Neonatal Drug Therapy Manual

Sodium Bicarbonate

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated December 1, 2023 - 4:00pm

Classification: 
Alkalinizing Agent
Original Date: 
June 1996
Revised Date: 
Dec 2023
Indications: 
  • Correction of metabolic acidosis
Administration: 
  • IV intermittent infusion
    • Central line preferred *
    • Use 4.2% (0.5 mmol/mL) strength undiluted*
    • Infusion rate: over 1 - 4 hours (maximum rate: 1 mmol/kg/hr)

 

  • IV direct: in emergency situation only
    • Central line preferred*
    • Use 4.2% (0.5 mmol/mL) strength undiluted*
    • Infusion time: over at least 2 minutes

 

* In emergency situation, may be given peripherally.  Further dilution in D5W is recommended, see recipe below. Sodium bicarbonate 4.2% is strongly hypertonic (1000 mOsm/L) and may cause vein damage.

 

Dosage: 
  • Calculated based on blood gases: 0.3 x weight (kg) x base deficit (> 5 - 10 mmol/L)
  • When acid-base status not available: 1 - 2 mmol/kg

*** A dose of 2 mmol/kg is expected to raise the pH by 0.1

Side Effects: 
  • CNS: tetany or hyperirritability (more likely to occur in patients with hypocalcemia)
  • CVS: edema
  • Endocrine and metabolic: metabolic alkalosis, if given in large doses or to patients with compromised renal failure
  • Local: tissue necrosis, ulceration after IV extravasation
Parameters to Monitor: 
  • Serum electrolytes
  • Arterial blood gases

 

Reconstitution and Stability: 

IV Administration:

  • Sodium Bicarbonate 4.2% (0.5 mmoL/mL)
  • NOTE: BACKORDER of the Sodium Bicarbonate 4.2% syringes
    • SUBSTITUTE: Sodium Bicarbonate 8.4% (1 mmoL/mL) syringes - DILUTE BEFORE USE
    • Instructions: dilute 8.4% sodium bicarbonate 1:1 with Sterile Water, to get 4.2% (0.5 mmoL/mL)

 

Specific Mixing Instructions (CHEO):
For IV direct in emergency situation only:

Take 10 mL of 8.4% Sodium bicarbonate (10 mmol) and add to 10 mL of SWFI
Final concentration: 4.2% (0.5 mmol/mL). Central line preferred. May be given peripherally.

For IV intermittent infusion in Central line/Peripheral Line*:

Take 10 mL 8.4% Sodium bicarbonate(10 mmol) and add to 10 mL of D5W or D10W
Final concentration: 4.2% (0.5 mmol/mL).

 

 

Specific Mixing Instructions (TOH):
For IV direct in emergency situation only:

Take 10 mL of 8.4% Sodium bicarbonate (10 mmol) and add to 10 mL of SWFI
Final concentration: 4.2% (0.5 mmol/mL). Central line preferred. May be given peripherally.

For IV intermittent infusion in Central line*:

Take 10 mL 8.4% Sodium bicarbonate(10 mmol) and add to 10 mL of D5W or D10W
Final concentration: 4.2% (0.5 mmol/mL).

For IV intermittent infusion in Peripheral line*:

Take 5 mL 8.4% Sodium bicarbonate (5 mmol) and add to 15 mL of D5W of D10W
Final concentration: 0.25 mmol/mL.

 

* 4.2% sodium bicarbonate is still quite hyperosmolar, and some sites will further dilute for peripheral administration

 

Compatibility: 

- Solution Compatible: D5W, 0.9% NaCl

- Y-site Compatible: fentanyl, gentamicin, heparin, morphine, potassium chloride (up to 40 mmol/L)

Incompatible: ampicillin, calcium gluconate (concentration dependent), dobutamine, dopamine, epinephrine, midazolam, SMOF

Notes: 
  • 1 mmol of sodium bicarbonate provides 1 mmol sodium
References: 

-Trissel LA. Handbook on Injectable Drugs. 16th Edition. Bethesda: American Society of Health-System Pharmacists; 2011

-Taketomo CK, Hodding JH, Kraus DM. Pediatric & Neonatal Dosage Handbook 20th Edition. Hudson: Lexi-Comp Inc.; 2013

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