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 (as they are equimolar)
• 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

Available preparations

Sodium bicarbonate 1.26% 75mmol (mEq) per 500ml infusion  (Braun polyfusor)

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

Bolus intravenous injection

• In emergency situations can give (8.4%) as a bolus injection

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

Dose in adults

Cardiac arrest

• Routine use is not recommended but see specialist guidelines

Metabolic acidosis

• Seek specialist advice regarding dosage
• Usually administered over 3 to 4 hours in an amount appropriate to body base deficit (ref 1)
• If acid-base status not available: give 2 to 5mmol/kg, infused over 4 to 8 hours (ref 2)
• 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

• Except in emergencies, Sodium bicarbonate 8.4% should be administered via a central venous catheter as it has an osmolarity of about 2000mOsm/L (ref 2)
• Hypertonic solution (greater than 1.4%) may cause venous irritation, and extravasation may lead to tissue necrosis
• Accidental intra-arterial administration of the 8.4% preparation may cause shock, or may lead to the loss of an extremity
• 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 25° C
• Do not refrigerate 

References

SPC 8.4% March 2018

1. Injectable medicines administration guide Medusa, downloaded 26th Feb 2019

2. Uptodate - accessed online 11th March 2019

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

Therapeutic classification

Electrolyte