Sodium Bicarbonate (34mg/ml) is an intravenous (IV) solution of a systemic alkalizer and electrolyte replenisher. It is a sterile, non-pyrogenic, hypertonic solution primarily used for the correction of metabolic acidosis and as a urinary alkalinizer. In the Indian context, it is a critical drug in emergency medicine, nephrology, and critical care settings, often used to manage acidosis secondary to conditions like diabetic ketoacidosis, renal failure, and severe sepsis.
Adult: Dose is highly individualized based on arterial blood gas (ABG) or serum bicarbonate levels. General guideline: 1-2 mEq/kg (approx. 50-100 mEq) IV over 1-2 hours initially. Further doses based on repeat ABG. For CPR: 1 mEq/kg IV bolus, repeated every 10 minutes if arrest is prolonged.
Note: For 34mg/ml (8.1%) solution: MUST be diluted before IV administration. Typically diluted in 5% Dextrose or 0.9% Sodium Chloride. Administer via a large-bore IV line in a large vein (e.g., antecubital) to minimize risk of tissue irritation and necrosis. Infusion rate should not exceed 1 mEq/kg/hour in routine correction. In emergencies (CPR), can be given as a slow IV push over 1-2 minutes.
Sodium bicarbonate dissociates in plasma to provide sodium (Na+) and bicarbonate (HCO3-) ions. The bicarbonate ion is a component of the body's primary extracellular buffer system (HCO3-/H2CO3). It combines with excess hydrogen ions (H+) to form carbonic acid (H2CO3), which rapidly dissociates into water (H2O) and carbon dioxide (CO2). The CO2 is then exhaled via the lungs. This reaction shifts the blood pH towards alkalinity, correcting metabolic acidosis.
Pregnancy: Category C (US FDA). Use only if clearly needed. No well-controlled studies. May cause maternal and fetal metabolic alkalosis. Benefits should outweigh risks.
Driving: No effect on driving ability.
| Potassium-Sparing Diuretics (e.g., Spironolactone, Amiloride) | Increased risk of hyperkalemia, especially in renal impairment. | Major |
| Corticosteroids (e.g., Prednisolone, Hydrocortisone) | Increased risk of sodium and fluid retention, edema, and hypertension. | Moderate |
| Lithium | Increased renal excretion of lithium, decreasing its serum levels and efficacy. | Moderate |
| Methotrexate | Urinary alkalinization can reduce renal clearance of methotrexate, potentially increasing toxicity. | Moderate |
| Quinidine, Flecainide | Urinary alkalinization decreases renal excretion, increasing their plasma levels and risk of toxicity. | Moderate |
| Salicylates (Aspirin) | Urinary alkalinization increases renal excretion of salicylates, used therapeutically in overdose. | Moderate (Therapeutic) |
Same composition (Sodium Bicarbonate (34mg/ml)), different brands: