sodium bicarbonate

sodium bicarbonate

Indication

• Treatment of metabolic acidosis or of bicarbonate deficit due to renal or GI losses

Dosage Guidelines

• Correction of metabolic acidosis/hyperkalemia with cardiac instability: 1-2 mmol/kg/dose may repeat every 10 minutes as needed
• Metabolic acidosis: Dose (mmol) = present weight (kg) x 0.3 x base deficit (mmol/L)
• Administer ½ the calculated dose then assess need for remainder

Administration

• ORAL: give with feeds
• IV direct: use the 0.5 mmol/mL solution and administer over at least 2 minutes (maximum rate 10 mmol/minute)
• IV infusion over 2 to 6 hours (slower infusion rates are preferred in preterm patients).  Maximum rate of infusion is 1 mmol/kg/hr

• The concentration of the infusion should always be 0.5 mmol/mL (4.2%) or less 

  To make 50 mL of sodium bicarbonate 0.5 mmol/mL solution:

1. Add 25 mL (25 mg) of sodium bicarbonate 1 mmol/mL (8.4%) to 25 mL of sterile water

Adverse Effects

• Alkalosis, hypernatremia, edema, hypercarbia, tissue necrosis and thrombosis

Comments

• Rapid administration may be associated with fluctuation in cerebral blood flow OR possibly IVH, carefully consider clinical need before administering
• The base deficit, serum bicarbonate and serum sodium should be monitored closely, and the infusion should be re-assessed every 2 hours
• Monitor IV site closely as sodium bicarbonate is a vesicant
• Incompatible with many medications, use a dedicated line when possible

Supplied As

• 4.2% (0.5 mmol/mL), 10mL Prefilled syringe (for resuscitation use only)
• 8.4% (1 mmol/mL), 50mL single use vial, (use to prepare a 4.2% solution for infusion).
• 0.5 mmol/mL (4.2%) IV syringe prepared by Pharmacy upon request
• 1 mmol/mL oral solution