Parenteral Manual

Sodium bicarbonate

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Alternate Name(s): 
NaHCO3
Classification: 
Electrolyte- Alkalinizing agent
Original Date: 
August 2005
Revised Date: 
March 2019
Indications: 
  • Emergency treatment of metabolic acidosis
  • Stabilization of acid base status in cardiac arrest (routine use is not recommended)
Reconstitution and Stability: 
  • Available as sodium bicarbonate 1 mmol/mL (8.4%) and sodium bicarbonate 0.5 mmol/mL (4.2%)
  • Store at room temperature.
  • DO NOT use if solution is not clear or contains a precipitate
  • Diluted solutions stable 24 hours
Compatibility: 

-Solutions Compatible: dextrose up to D10W, saline solutions, dextrose-saline combinations

- Additive/Above Cassette Compatible: KCl (up to 120 mmoL/L)

-Y-site Compatible: KCl (up to 40 mmol/L), propofol, piperacillin/tazobactam

- Incompatible: acids, acidic salts, amiodarone, atropine, many alkaloidal salts, calcium salts,  cefotaxime, cefuroxime, ciprofloxacin, dopamine, dobutamine, epinephrine, glycopyrrolate, hydromorphone, imipenem, isoproterenol, labetalol, magnesium salts, metoclopramide, midazolam, norepinephrine, pentobarbital, ringer's lactate, ringer's solution,  succinylcholine, thiopental, TPN

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES, emergency situation only
Usual dilution:
-  less than 2 years: 0.5 mmoL/mL
-  greater than or equal to 2 years: 1 mmoL/mL

Infusion rate: do not exceed 1-2 mmoL/kg/min (maximum 10 mmoL/min)
IV Intermittent Infusion

YES
Usual dilution:
- less than 2 years: 0.5 mmoL/mL
- greater than or equal to 2 years: 1 mmoL/mL

-  Peripheral line: 0.5 mmoL/mL
-  Central line: 1 mmoL/mL

Infusion time: 2-8 hours
Infusion rate: do not exceed 1 mmoL/kg/hr
IV Continuous Infusion

YES
Usual dilution:

- less than 2 years: 0.5 mmoL/mL
- greater than or equal to 2 years: 1 mmoL/mL

-  Peripheral line: 0.5 mmoL/mL
-  Central line: 1 mmoL/mL
  • 0.5 mEq/mL = 4.2% sodium bicarbonate undiluted = 0.5 mmol/mL
  • 1 mEq/mL = 8.4% sodium bicarbonate undiluted = 1 mmol/mL
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Cardiac Arrest:

  • 1 mmoL/kg slow IV push; may repeat once with 0.5 mmoL/kg in 10 minutes or as indicated by the patient's acid-base status

Metabolic Acidosis:   
- Neonates, Infants, and Children:  

  • HCO3 (mmoL) = 0.3 x weight (kg) x base deficit (mmoL/L) or
  • HCO3 (mmoL) = 0.5 x weight (kg) x [24 - serum HCO3 (mmoL/L)]

Toxicology - Urinary Alkalinization for Salicylate Overdose:

  • Add 150 mmol sodium bicarbonate (ie 150 mL of sodium bicarbonate 8.4%) to 850 mL of D5W (final volume 1000 mL). The addition of KCL 20 or 40 mmol/L to the bag may be necessary as correction of hypokalemia is required to achieve alkaline diuresis. Aim for urinary pH > 7.5. Give by continuous infusion at 2 - 3 mL/kg/hr OR give at 1.5 x maintenance to achieve urine flow of 2 - 3 mL/kg/hr.

 

High dose methotrexate

If urine pH < 7.0 during methotrexate infusion, give 25 mmoL/m2 of NaHC03 IV over 15 minutes

Draw up patient’s dose into a syringe at a concentration of 1 mmol/mL

Administer on syringe pump

Adults:    

  • HCO3 (mmoL) = 0.2 x weight (kg) x base deficit (mmoL/L) or
  • HCO3 (mmoL) = 0.5 x weight (kg) x [24 - serum HCO3 (mmoL/L)]

If acid-base state unavailable:  (Pediatric and Adult)

  • 2-5 mmoL/kg IV infusion over 4-8 hours; subsequent doses based on patient's acid-base status
Potential hazards of parenteral administration: 
  • Extravasation may cause local ischemia and tissue necrosis
  • Hypernatremia, hypokalemia, hypocalcemia, hyperosmolality
  • Metabolic alkalosis (hyperexcitability, irritability, restlessness, tetany)
  • Intracranial hemorrhage (especially with rapid injection of hypertonic sodium bicarbonate in children less than 2 years)
  • Edema
Notes: 
  • Patient should have adequate alveolar ventilation before administering sodium bicarbonate

  • Monitor serum electrolytes, arterial blood gases, urinary pH

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