- 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
- 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
- Serum electrolytes
- Arterial blood gases
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