Description

Sodium bicarbonate is a chemical compound made of sodium (Na+) and bicarbonate (HCO3-), for which the indications are many.

FDA approved indications include:

Cardiac conduction delays
QRS prolongation (ex. tricyclic antidepressant poisoning)

Under arrhythmias and cardiovascular instability,NaHCO₃ can be administered to adults at 4 to 8 hour IV infusions. Each dose should be monitored and planned in a standard protocol to help evaluate the degree of response expected and predicted to understand the necessity to advance further infusions or withhold administration, given its fluid overloading effects.

Metabolic acidosis, related to:

Severe renal disease
Uncontrolled diabetes
Severe primary lactic acidosis
Circulatory insufficiency due to shock
Severe dehydration
Extracorporeal circulation of blood
Cardiac arrest
Drug toxicities
Barbiturates
Salicylate
Toxic alcohols
Urine alkalization
Severe diarrhea with HCO3 loss

Non-FDA approved indications:

Nebulized NaHCO₃ is an excellent option to treat chemical injuries resulting from chlorine gas, especially within the pulmonary mucosa. The belief is that the inhaled gas neutralizes when it reacts with water and bicarbonate within the respiratory system.

NaHCO3 comes in various forms, including oral tablets, IV injections, and IV infusions.

Oral formulations are available via powder, 325 mg, and 650 mg oral tablets.

1 mEq NaHCO3 is 84 mg. 1000 mg = 1 gram of NaHCO3 contains 11.9 mEq of sodium and bicarbonate ions. One 650 mg tablet of NaHCO3 has 7.7 mEq of sodium and bicarbonate ions.

Sodium bicarbonate

The two primary IV injection formulations of NaHCO3 are as follows:

• 7.5% concentration = 44.6 mEq NaHCO3 in 50 mL. 7.5% concentration supplies 75 mg/mL, which also consists 0.9 mEq/mL for each sodium and bicarbonate.
• 8.4% concentration = 50 mEq in 50 mL. 8.4% concentration supplies 84 mg/mL, which also consists 1 mEq/mL for each sodium and bicarbonate. One ampoule of 50 ml contains 50 mEq sodium and 50 mEq bicarbonate to a total of 100 mEq/50 mL and corresponds to 2000 mosm per liter. This formulation is a hypertonic solution and can raise serum sodium concentration with the attraction of water to the extracellular areas from the intracellular area.
• A 4.2% and 5% solution are also available, though not as often used given the dosing availability of larger concentrations.

NaHCO3 IV infusions are available in the following formulations:

• 50 mEq, 75 mEq, 100 mEq NaHCO3 in 1L of 0.45% NS, 0.45%NS+D5W, or D5W
• 50 mEq, 75 mEq, 100 mEq and 150 mEq NaHCO3 in 1L D5W or Sterile water
• Bicarbonate tablets are available as 650mg NaHCO3, 25 to 50 mEq KHCO3, 20 to 40 mEq KHCO3-citric acid, and 20 to 50 mEq KHCO3-KCl tablets.

Common Uses of Sodium Bicarbonate

Cardiac arrest: Currently, routine bicarbonate administration for cardiac arrest is no longer a recommendation. It should only be administered for cardiac arrest due to hyperkalemia or tricyclic antidepressant overdose, or metabolic acidosis. Dosing is 1 mEq/kg per dose, repeated according to arterial blood gas measurements. Sodium bicarbonate should ideally be given after adequate alveolar ventilation and the initiation of cardiac compressions.

Acute metabolic acidosis: If pH is less than 7.1 or pH less than 7.1 to 7.2 in patients with severe acute kidney injury (oliguria or 2-fold or larger increase in serum creatinine level)

Chronic metabolic acidosis: 50 to 100 mEq oral tablet can be initiated and titrated according to the ongoing evaluation of acid-base balance.

Sodium bicarbonate

Lactic acidosis:

The use of sodium bicarbonate remains controversial but is an option if pH is below 7.

Diabetic ketoacidosis: The use ofNaHCO₃ remains controversial in diabetic ketoacidosis since recovery outcome is similar with or without NaHCO3. However, sodium bicarbonate is still recommended if the pH is below 7 after 1 hour of fluid administration. Sodium bicarbonate should be given in hypotonic fluid every two hours until pH is at least 7.

Hyperkalemia: When patients with severe hyperkalemia (serum potassium level of more than 6 mEq/L or more than 5.5 mEq/L with arrhythmia or EKG changes) have metabolic acidosis, NaHCO₃ should be administered.

The dose needed is empirical and is unpredictable. Initially, 150 mEq of sodium bicarbonate can be given in 1 liter of 5% dextrose over 4 hours. More can be given if acidosis does not correct with this regimen.

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