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.

Alkalinizing Agent
Original Date: 
June 1996
Revised Date: 
May 2014
  • Correction of metabolic acidosis
  • 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.


  • 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: 

For peripheral IV administration:

  • Sodium bicarbonate 4.2% (0.5 mmol/mL)
    • Take 10 mL (5 mmol) and add to 10 mL of D5W
    • Final concentration: 0.25 mmol/mL

- 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

  • 1 mmol of sodium bicarbonate provides 1 mmol sodium

-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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