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
