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Administration

Dosage Forms and Strengths

NaHCO3 comes in various forms, including oral tablets, IV injections, and IV infusions. Oral formulations are available via 325 mg powder and 650 mg oral tablets. One mEq NaHCO3 is 84 mg. One 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.

The 2 primary IV injection formulations of NaHCO3 are:

NaHCO3 IV infusions are available in the following formulations:

In patients with arrhythmias and cardiovascular instability, sodium bicarbonate can be administered to adults with 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.

Adult Dosage

Acute metabolic acidosis: 2 to 5 mEq/kg/dose IV for a single dose; subsequent dosing based on patient response and acid-base status.

Chronic metabolic acidosis:

Lactic acidosis: Using sodium bicarbonate remains controversial but is an option if pH is below 7.[11]

Diabetic ketoacidosis: The use of sodium bicarbonate remains controversial in diabetic ketoacidosis since recovery outcomes are similar with or without NaHCO3. However, if the pH is below 7 after 1 hour of fluid administration, sodium bicarbonate is still recommended. Sodium bicarbonate should be given in hypotonic fluid every 2 hours until pH is 7 or higher.[12]

Salicylate overdose: 1 to 2 mEq/kg/dose IV for a single dose

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, sodium bicarbonate should be administered. The dose needed is empirical and unpredictable. Initially, 150 mEq of sodium bicarbonate can be given in 1 liter of 5% dextrose over 4 hours. More can be provided if acidosis is not corrected with this regimen.[13] If there is a need to decrease serum potassium emergently, 50 mEq of NaHCO3 IV can be given over 5 minutes, followed by other methods of potassium reduction.

Urinary alkalinization: 975 to 1950 mg orally every 4 hours, starting with 3900 mg orally for a single dose

Dyspepsia: varies with age

Cardiac arrest: Currently, routine bicarbonate administration for cardiac arrest is no longer a recommendation. The agent should only be administered for cardiac arrest due to hyperkalemia, tricyclic antidepressant overdose, or metabolic acidosis.[14] 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.

Specific Patient Population