- Type: 8.4% is common cardiac formulation
- 8.4% is 1 mEq/mL
- Dosage Forms: 5% ; 7.5% ; 8.4% ; 4.2% ; 4% ; 325mg ; 150 mEq/1000 mL-D5% ; 150 mEq/1150 mL-D5%
- Routes of Administration: IV
- Common Trade Names: N/A
- Abbreviation: NaHOC3
50 mL (1 amp) IV push for severe acidemia and patient is adequately ventilated
- 1 mEq/kg IV bolus dose initially (~1-2 amps for average adult)
- 0.5 mEq/kg/dose q10min
- OR tailor to serial ABGs
Severe Metabolic Acidemia (pH<7.1)
- IV drip
- 150 mEq/1000 mL inD5W
- May reduce 28 day mortality in patients with severe AKI and decrease need for dialysis (although this study used 4.2% sodium bicarbonate, a product not widely available within the United States)
Serum alkalinization (toxicology)
- Enhance urinary elimination of salicylates, methotrexate and phenobarbital
- Goal: serum pH of 7.5, urinary pH of 8.0
- Check K+ as well
- IV drip
- 150 mEq (3 amps) of 8.4% solution in 1000 ml D5W + potassium 20-40 mEq, max. 250 cc/hour
- 1 mL/kg IV push for severe acidemia and patient is adequately ventilated
- Sodium bicarbonate administration in cardiac arrest has not been shown to improve survival to discharge
- ACLS guidelines recommend against routine use of sodium bicarbonate in cardiac arrest although there may be benefit in the setting of cardiac arrest caused by hyperkalemia or tricyclic antidepressant overdose
- Allergy to class/drug
- Ongoing chloride loss (vomiting, gastrointestinal suction, with concurrent diuretics that induce hypochloremia)
- Extravasation- cellulitis, tissue necrosis, ulcer
- Metabolic alkalosis
- Hypernatremia 
- Onset: 15 minutes (IV)
- Duration: 1-2 hours (IV)
Mechanism of Action
- Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH
- Sodium acetate can be used as a substitute for sodium bicarbonate during times of critical shortages
- Can be used to treat TCA and ASA toxicity
- Cannot be given as a rapid bolus - give 1 mEq/kg over 15-20 minutes to avoid hypotension
- eMedicine. Sodium Bicarbonate. http://reference.medscape.com/drug/sodium-bicarbonate-antidote-343749
- Jaber, S., Paugam, C., Futier, E., Lefrant, J.-Y., Lasocki, S., Lescot, T., … BICAR-ICU Study Group. (2018). Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. The Lancet, 392(10141), 31–40.
- Dybvik T, Strand T, Steen PA. Buffer therapy during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 1995 Apr;29(2):89-95. doi: 10.1016/0300-9572(95)00850-s. PMID: 7659873.
- Vukmir RB, Katz L; Sodium Bicarbonate Study Group. Sodium bicarbonate improves outcome in prolonged prehospital cardiac arrest. Am J Emerg Med. 2006 Mar;24(2):156-61. doi: 10.1016/j.ajem.2005.08.016. PMID: 16490643.
- Aufderheide TP, Martin DR, Olson DW, Aprahamian C, Woo JW, Hendley GE, Hargarten KM, Thompson B. Prehospital bicarbonate use in cardiac arrest: a 3-year experience. Am J Emerg Med. 1992 Jan;10(1):4-7. doi: 10.1016/0735-6757(92)90115-e. PMID: 1736913.
- Neavyn MJ,Boyer EW, Bird SB, Babu KM. Sodium Acetate as a Replacement for Sodium Bicarbonate in Medical Toxicology: a Review. J Med Toxicol. 2013;9:250–254.