sodium bicarbonate

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

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 requiring infusion: Dose (mmol) that will provide a half correction of the Base deficit = [current weight (kg) x 0.6 (percentage total body water in L/kg) x base deficit (mmol/L)] divided by 2
  • The typical dose required for a half correction is 0.5-1 mmol/kg/hour

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

    Sample Calculation

    A 2.6 kg baby is prescribed an infusion of sodium bicarbonate 0.75 mmol/kg/hr to infuse over 6 hours

    Sodium bicarbonate for neonates must be a 0.5 mmol/mL solution for infusion (equivalent to 4.2%)

    0.75 mmol/kg/hr x 2.6 kg = 1.95 mmol/hr

    To calculate the rate to be infused in mL/hr: 1.95 mmol/hr / 0.5 mmol/mL = 3.9 mL/hr

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 6 hours as needed
  • Monitor IV site closely as sodium bicarbonate is a vesicant
  • Incompatible with many medications including amino acids/dextrose, use a dedicated line when possible

Supplied As

  • 4.2% (0.5 mmol/mL), 10 mL Prefilled syringe (for resuscitation use only)
  • 8.4% (1 mmol/mL), 50 mL 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
References

LexiComp Sick Kids, LexiComp Pediatric and Neonatal, Neofax