Adult: Severe cases (e.g. cardiac arrest): Usual dose: 1 mmol/kg (1 mL/kg of 8.4% Na bicarbonate solution) via inj, followed by 0.5 mmol/kg given at 10-minute intervals depending on individual arterial blood gases. Less urgent cases: 2-5 mmol/kg given via infusion over 4-8 hours based on the severity of acidosis as judged by the decrease of total CO2 content, blood pH, and clinical condition of patient. Dosage recommendations may vary in the country of use (refer to local treatment protocol and guidelines). Child: Severe cases (e.g. cardiac arrest): Usual dose: 1 mmol/kg (1 mL/kg of 8.4% Na bicarbonate solution) via slow inj. In premature infants and neonates up to 2 years: Dilute the 8.4% solution with 5% dextrose (1:1 ratio) or use the 4.2% solution. Give dose via slow inj. Max: 8 mmol/kg/day. Dosage recommendations may vary in the country of use (refer to local treatment protocol and guidelines).
Oral Metabolic acidosis
Adult: Dosage calculation is individualised according to acid-base balance and electrolyte status of the patient.
Oral Dyspepsia
Adult: 1-5 g 4-6 hourly as necessary. Alternatively, 0.65-2.6 g 4 hourly.
Administration
May be taken with or without food. Do not take on an overly full stomach. Consult product literature for specific instructions.
Reconstitution
IV infusion: Dilute with 5% dextrose or 0.9% NaCl inj.
Incompatibility
Incompatible with norepinephrine, dobutamine hydrochloride, dopamine hydrochloride, epinephrine, ascorbic acid, cisplatin, carmustine, glycopyrrolate, insulin, labetalol hydrochloride, Mg sulfate, morphine sulfate, oxytetracycline hydrochloride, streptomycin sulfate, tetracycline hydrochloride, vancomycin hydrochloride, lactated Ringer’s inj, dextrose 5% in lactated Ringer’s inj. Avoid adding to solutions containing Ca (except where compatibility has been previously established).
Contraindications
Metabolic or respiratory alkalosis, hypocalcaemia, hypochlorhydria, severe pulmonary oedema, unknown abdominal pain. IV: Conditions with Na intake restrictions (e.g. renal failure), hypoventilation, history of urinary calculi, coexisting K depletion, hypernatraemia. Patient with chloride loss due to vomiting or continuous gastrointestinal suction. IV: Concomitant use with diuretics known to produce hypochloraemic alkalosis.
Special Precautions
Patient with CHF, hypertension, cirrhosis, on low Na diet; eclampsia, oedema, aldosteronism or other conditions associated with Na retention; oliguria or anuria. Avoid extravasation (IV). Renal and hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Metabolic alkalosis, hypernatraemia; fluid and/or solute overload (IV); tissue necrosis, vascular irritation or sloughing (IV extravasation); decreased CSF pressure and intracranial haemorrhage (rapid IV inj in neonates). Gastrointestinal disorders: Abdominal pain, flatulence, spontaneous stomach rupture, nausea, vomiting, unpleasant taste. General disorders and administration site conditions: Unusual tiredness or weakness. Metabolism and nutrition disorders: Fluid retention, hypocalcaemia, exacerbated hypokalaemia, loss of appetite. Musculoskeletal and connective tissue disorders: Muscle spasms or cramps. Nervous system disorders: Headache, restlessness. Psychiatric disorders: Mood or mental changes, nervousness, extreme irritability. Renal and urinary disorders: Frequent urge to urinate. Respiratory, thoracic and mediastinal disorders: Pulmonary oedema, breathing difficulty, fluid in the lungs. Vascular disorders: Hypertension.
Hemodialysis/IV/Parenteral/PO: Z (May cause adverse effects (e.g. metabolic alkalosis, fluid overload) in mother and foetus. Consult product literature or clinical guidelines for specific recommendations.)
Monitoring Parameters
Monitor serum electrolytes, including serum Ca; urinary pH, arterial blood gases if necessary. IV: Perform arterial blood gas analyses, especially arterial/venous blood pH and CO2 levels, prior to and during the treatment course. Monitor cardiac status, infusion site, and for signs of fluid retention.
Overdosage
Symptoms: Metabolic alkalosis, Na overload, hyperosmolarity, hyperventilation, paradoxical acidosis of CSF, severe hypokalaemia; Severe: hyperirritability, tetany, shortness of breath, muscle weakness, convulsions, and coma. Management: Supportive treatment. Discontinue Na bicarbonate administration. Correct fluid and electrolyte imbalance using Na-free fluids. Rebreathe expired air. May administer Ca gluconate to control hyperirritability and tetany. For severe alkalosis, may give ammonium chloride in patients without pre-existing hepatic disease. Administer K chloride for hypokalaemia.
Drug Interactions
Increased excretion of lithium, aspirin, methotrexate. Reduced excretion of quinidine, amphetamines, methadone, quinine, and ephedrine. Reduced absorption of tetracycline, rifampicin, ketoconazole, dipyridamole, chloroquine, phenothiazines, phenytoin, penicillamine. May increase the renal tubular reabsorption of mecamylamine. May reduce the serum K concentration with K supplements. Potentially Fatal: May cause hypochloraemic alkalosis with K-depleting diuretics (e.g. bumetanide, ethacrynic acid, furosemide, thiazides).
Action
Description: Mechanism of Action: Sodium bicarbonate is a systemic alkalinising agent. It increases blood and urinary pH by dissociation to provide bicarbonate ions, which neutralises the hydrogen ion concentration. Onset: 15 minutes (oral); rapid (IV). Duration: 1-3 hours (oral); 8-10 minutes (IV). Pharmacokinetics: Absorption: Readily and well absorbed from the gastrointestinal tract. Distribution: Present in all body fluids. Metabolism: Not significantly metabolised. Excretion: Via urine (<1%).
Chemical Structure
Sodium bicarbonate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 516892, Sodium bicarbonate. https://pubchem.ncbi.nlm.nih.gov/compound/Sodium-bicarbonate. Accessed Aug. 25, 2020.
Storage
Store between 15-30°C. Protect from heat. Do not freeze.
B05XA02 - sodium bicarbonate ; Belongs to the class of electrolyte solutions used in I.V. solutions. B05CB04 - sodium bicarbonate ; Belongs to the class of salt solutions used as irrigating solutions.
References
AFT Pharmaceuticals Ltd. Sodium bicarbonate 8.4% w/v Injection data sheet October 2018. Medsafe. http://www.medsafe.govt.nz/. Accessed 03/06/2020.Anon. Sodium Bicarbonate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/06/2020.Buckingham R (ed). Bicarbonate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2020.HSP Sodium bicarbonate Injection 8.4% (Hospira, Inc.). MIMS Malaysia. http://www.mims.com/malaysia. Accessed 03/06/2020.Joint Formulary Committee. Sodium Bicarbonate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/06/2020.Sodium Bicarbonate 1.26% Solution for Infusion (Fresenius Kabi Limited). MHRA. https://products.mhra.gov.uk/. Accessed 20/07/2020.Sodium Bicarbonate 10 gr (650 mg) Tablet (CitraGen Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/06/2020.Sodium Bicarbonate 500 mg Capsules (Teva UK Limited). MHRA. https://products.mhra.gov.uk/. Accessed 03/06/2020.Sodium Bicarbonate 8.4% w/v Solution for Injection (Macarthys Laboratories Ltd t/a Martindale Pharma). MHRA. https://products.mhra.gov.uk/. Accessed 03/06/2020.Sodium Bicarbonate 84 mg/mL Oral Solution (Ennogen Healthcare Ltd). MHRA. https://products.mhra.gov.uk/. Accessed 03/06/2020.Sodium Bicarbonate Injection (International Medication Systems, Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 03/06/2020.
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