Sodium bicarbonate Intravenous for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• Any reference to mmol refers to both sodium and bicarbonate
• Equivalencies: 1mmol is equivalent to 1mEq bicarbonate
• Except in emergencies, the 8.4% infusion MUST be given via a central line
• See monitoring requirements overleaf
• Significant sodium content (1mmol per mL)

Available preparations

Sodium bicarbonate 1.26% 75mmol (mEq) per 500mL infusion (Braun polyfusor) ^{(intermittent supply issues- see under Further information below re preparation of this solution using higher strength infusion)}

Sodium bicarbonate 8.4% 100mmol(mEq) per 100mL infusion (Braun)

Sodium bicarbonate 8.4% in 10mmol (mEq) per 10mL (Martindale) (unlicensed)

Reconstitution

Already in solution

Infusion fluids

• Not required (product ready for use as is)
• If required the 8.4% infusion may be further diluted with Glucose 5% - see under further information

Methods of intravenous administration

Slow intravenous injection

• In emergency situations can give (8.4%) over at least 3 minutes ^{(ref 1)}

Intermittent intravenous infusion (administer using an electronically controlled infusion device)

• Peripheral line - use 1.26% strength
• Central line - use any strength up to 8.4%
• See under 'Dose' below for more detail

Maximum infusion rates ^{(ref 1)}:

• Maximum infusion 1.5mmol/kg/hour is equivalent to the following infusion rates for different concentrations:
  • Central venous access device: 1.5mL/kg/hour of a 8.4% solution
  • Peripheral venous access device: 10mL/kg/hour of a 1.26% solution

Dose in adults

Cardiac arrest

• Routine use is not recommended but see specialist guidelines

Metabolic acidosis

• Seek specialist advice regarding dosage
• Correction of metabolic acidosis should not be effected too rapidly
• It is advisable to start administering only half of the calculated dose and adjust further doses according to the actual results of blood gas analysis.
• The dose depends on the degree of the disorder of the acid-base status
• According to the blood gas values the amount to be administered is calculated applying the following formula:
  • mmol sodium bicarbonate = base deficit x kg body weight x 0.2**
  • **(The factor 0.2 corresponds to the proportion of the extracellular fluid in relation to total body weight.)
• Example:
  • If in a patient of 70 kg bodyweight the base deficit is 5 mmol/l, then
  • 5 x 70 x 0.23 = 70mmol of sodium bicarbonate ( 70 ml of 8.4 % w/v Sodium Bicarbonate Intravenous Infusion BP)are to be given.
• Subsequent doses should be adjusted to patient's requirements

Tumour lysis syndrome ^{(ref 3)}

• The EVIQ cancer treatment guidelines state that sodium bicarbonate is not recommended due to a lack of clear evidence demonstrating benefit
• Urinary alkanisation should be avoided in patients with tumour lysis syndrome especially when rasburicase is available

Prevention of contrast-induced nephropathy (unlicensed use):

• Using the 1.26% polyfusor give 3ml/kg for ONE hour immediately before contrast, then 1ml/kg/hour during procedure and for SIX hours after procedure ^{(ref 2)}

Monitoring

• Monitor pH, serum bicarbonate, and arterial blood gases ^{(ref 1)}
• Frequent monitoring of serum electrolyte concentrations and acid-base status is essential during treatment
• Watch for consequences of sodium load
• Monitor for extravasation

Further information

• Concentrations over 1.4% should ideally be given via a central venous access device but in emergencies, may be given via a peripheral venous access device ^{(ref 1)}
  • Hypertonic solution (greater than 1.4%) may cause venous irritation, and extravasation may lead to severe tissue damage ^{(ref 1)}
• Accidental paravenous administration may lead to tissue necrosis
• Additions of other drugs should never be made to sodium bicarbonate infusions, particularly calcium and magnesium salts ^{(ref 1)}

Dilution of Sodium bicarbonate (8.4%) infusion

• As Sodium bicarbonate 8.4% has a very high osmolarity and ideally should only be given via a central line, it may occasionally be necessary to dilute this strength.
• However, it is preferable to use a premade infusion bag containing 1.26% sodium bicarbonate.
• If the pre-mixed polyfusor 1.26% is not available, a 1.26% concentration may be prepared as follows:
• Remove 75ml from Glucose 5% 500ml bag, add 75ml of Sodium bicarbonate 8.4% to the remaining 425ml in the bag.
• Mix well by inverting the bag several times
• While it is possible to use Sodium chloride 0.9% or 0.45% to prepare the 1.26% concentration, this is generally not done due to the increased sodium load.

Storage

• Store below 25⁰C
• Do not refrigerate

References

SPC 8.4% August 2017

1. Injectable medicines administration guide Medusa, downloaded 4th March 2025

2. Uptodate - accessed online 4th March 2025

3. EVIQ guidelines: Prevention and management of Tumour Lysis Syndrome 25th May 2018

Therapeutic classification

Electrolyte